Cocaine‐induced ventricular fibrillation: protection afforded by the calcium antagonist verapamil

Billman, George E.; Hoskins, Richard S.

doi:10.1096/fasebj.2.14.3181653

Cited by 51 publications

(5 citation statements)

References 15 publications

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“…In dog models of ischaemia followed by cocaine use verapamil, nifedipine and diltiazem all protected against ventricular arrhythmias [65,66]. In these models magnesium was also effective.…”

Section: Treatment Of Arrhythmias Resulting From Cocaine-associated Mmentioning

confidence: 99%

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Hoffman

2010

Brit J Clinical Pharma

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Widespread use of cocaine and its attendant toxicity has produced a wealth of benchwork studies and small animal investigations that evaluated the effects of cocaine on the cardiovascular system. Despite this wealth of knowledge, very little is known about the frequency or types of arrhythmias in patients with significant cocaine toxicity. The likely aetiologies; catecholamine excess, sodium channel blockade, potassium channel blockade, calcium channel effects, or ischaemia may act alone or in concert to produce a vast array of clinical findings that are modulated by hyperthermia, acidosis, hypoxia and electrolyte abnormalities. The initial paper in the series by Wood & Dargan providing the epidemiological framework of cocaine use and abuse is followed by a detailed review of the electrophysiological effects of cocaine by O'Leary & Hancox. This review is designed to complement the previous papers and focuses on the diagnosis and treatment of patients with cocaine‐associated arrhythmias.

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“…In dog models of ischaemia followed by cocaine use verapamil, nifedipine and diltiazem all protected against ventricular arrhythmias [65,66]. In these models magnesium was also effective.…”

Section: Treatment Of Arrhythmias Resulting From Cocaine-associated Mmentioning

confidence: 99%

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Hoffman

2010

Brit J Clinical Pharma

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“…Use of amiodarone with cocaine in an animal model did not show survival benefit . Use of calcium channel blockers has shown reduction in arrhythmia probably due to the coronary vasodilatory effects in subjects with cocaine induced arrhythmias …”

Section: Discussionmentioning

confidence: 94%

Radiofrequency Ablation of Drug Refractory Ventricular Tachycardia Related to Cocaine Use: A Feasibility, Safety, and Efficacy Study

Lakkireddy

Kanmanthareddy

Biria

et al. 2014

Cardiovasc electrophysiol

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Background Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation. Objectives We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry. Methods Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed. Results A total of 14 subjects met study criteria (age 44 ± 13, range 18-to 68-year-old with 79% male, 71% Caucasian). MRI showed evidence of scar only in 43% of patients (6/14). The mechanism of VT was focal in 50% (n = 7) and scar related reentry in 50% (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16% (3/18) of VTs. Most clinical VTs were hemodynamically stable (75%). Mean ejection fraction at the time of admission was 44 ± 14%. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86% (1 case lost to follow-up and 2 died). Conclusion Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.

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“…44 Animal studies indicate post-MI episodes of ventricular fibrillation after cocaine exposure are reduced by verapamil. 45 A prospective study of 10 patients with hypertension and active cocaine use indicated that 1 of 10 patients had nonsustained VT. 46 In a study of 45 hospitalized patients for cocaine abuse, those with chest pain (CP) had a longer QTc intervals (510 ms) versus those with no CP (459 ms). Among patients with CP, 13% had sustained ventricular arrhythmias; all had repolarization abnormalities.…”

Section: Cocaine and Atrial Arrhythmiasmentioning

confidence: 99%

“…44 Animal studies indicate post-MI episodes of ventricular fibrillation after cocaine exposure are reduced by verapamil. 45…”

Section: Cocainementioning

confidence: 99%

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Dominic

Ahmad

Awwab

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effects on the conduction system and through several direct and indirect pathways, utilizing multiple second messenger systems, change the structural and electrical substrate of the heart, thereby promoting cardiac dysrhythmias. Substituted amphetamines and cocaine affect the expression and activation kinetics of multiple ion channels and calcium signaling proteins resulting in EKG changes, and atrial and ventricular brady and tachyarrhythmias. Preexisting conditions cause substrate changes in the heart, which decrease the threshold for such drug-induced cardiac arrhythmias. The treatment of cardiac arrhythmias in patients who take drugs of abuse may be specialized and will require an understanding of the unique underlying mechanisms and necessitates a multidisciplinary approach. The use of primary or secondary prevention defibrillators in drug abusers with chronic systolic heart failure is both sensitive and controversial. This review provides a broad overview of cardiac arrhythmias associated with stimulant substance abuse and their management.

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Cocaine‐induced ventricular fibrillation: protection afforded by the calcium antagonist verapamil

Cited by 51 publications

References 15 publications

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Radiofrequency Ablation of Drug Refractory Ventricular Tachycardia Related to Cocaine Use: A Feasibility, Safety, and Efficacy Study

Stimulant Drugs of Abuse and Cardiac Arrhythmias

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