Disopyramide for Hypertrophic Cardiomyopathy: A Pragmatic Reappraisal of an Old Drug

Abstract

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disorder characterized by unexplained left ventricular hypertrophy in the absence of other cardiac or systemic etiologies. Approximately two-thirds of patients with HCM develop left ventricular outflow tract (LVOT) obstruction with or without provocation, whereas nearly half develop heart failure with preserved ejection fraction. Medical management of heart failure with preserved ejection fraction is based on the presence of symptoms and LVOT obstruction and frequently includes β-blockers or verapamil. Disopyramide is a class Ia antiarrhythmic that historically was used for the treatment of arrhythmias; however, its contemporary use is often reserved for patients with HCM who are persistently symptomatic despite β-blockers or verapamil and have evidence of LVOT obstruction. The pharmacologic rationale for use of disopyramide is largely based on its strong negative inotropic property. Three clinical studies have showed significant improvements in heart failure symptoms and a reduction in the need for invasive therapy in patients treated with disopyramide. Appropriate dosing and monitoring of disopyramide are important to mitigate the potential for anticholinergic adverse events and proarrhythmias. Disopyramide is a safe and effective medication that reduces heart failure symptoms and LVOT gradient and delays the need for invasive therapy in patients with obstructive HCM.

Disopyramide for Hypertrophic Cardiomyopathy

“…It is recommended to consider adding disopyramide to a beta blocker or verapamil therapy to treat angina or dyspnea if there is no response to these treatments alone. This should be avoided in patients with reduced systolic function [7].…”

“…It is a sodium channel blocker with negative inotropic properties that effectively reduces left ventricular outflow tract gradients in adults with HCM [8]. Patients with HCM who are persistently symptomatic despite the use of β-blockers or verapamil and have evidence of LVOT obstruction are prescribed disopyramide [7]. Disopyramide could improve LV diastolic dysfunction in patients with hypertrophic nonobstructive cardiomyopathy (HNCM) [9].…”

Pharmacological Management of Hypertrophic Cardiomyopathy: From Bench to Bedside

“…The strong negative inotropic effect of disopyramide prompted its use for the treatment of symptomatic HCM associated with LVOTO [ 35 ]. In 1988, a study involving seven oHCM patients by Sherrid and co-workers reported a solid reduction of the LVOT gradient and an amelioration of diastolic function exerted by disopyramide [ 36 ].…”

Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology

“…The need for hospital admission to monitor for potential arrhythmogenicity may disrupt training or competition schedules. [ 79 ] As a result of this potential side effect, guidelines recommend concomitant use of an atrioventricular nodal-blocking agent [ 2 ••].…”