Effect of Antiarrhythmic Drug Therapy on the Incidence of Shocks in Patients who Receive an Implantable Cardioverter Defibrillator after a Single Episode of Sustained Ventricular Tachycardia/Fibrillation

Kou, William H.; Kirsh, Marvin M.; Bolling, S. F.; Stirling, Mack C.; Kadish, Alan H.; Buitleir, Michael de; Calkins, Hugh; Lewis, R. R.; Morady, Fred

doi:10.1111/j.1540-8159.1991.tb02733.x

Cited by 20 publications

(4 citation statements)

References 8 publications

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“…Pharmacologic therapy may also decrease the frequency of episodes of VT, supraventricular tachycardias and atrial fibrillation (AF), slow the ventricular response to AF, reduce incidence of shock-induced AF, control sinus rate in active patients, and therefore decrease total patient exposure to ICD shocks Until recently it was not clear whether any of the goal of antiarrhythmic drug therapy in ICD recipients are actually achieved. In the original retrospective and nonrandomized studies comparing frequency of device discharges between patients with ICDs treated with either amiodarone or no antiarrhythmic drug therapy, there were no statistically significant differences in the time to first shock delivery or the frequency of device use between the two groups of patients [31,32]. In a small prospective randomized study, Anderson et al [33] noted no significant difference in time to first shock delivery and the frequency of device use between patient randomized to the "best drug" therapy versus no therapy.…”

Section: Antiarrhythmic Therapy In Recipients Of Implantable Cardiovementioning

confidence: 97%

Interactions of antiarrhythmic drugs with implantable defibrillator therapy for atrial and ventricular tachyarrhythmias

Król¹,

Saksena²,

Prakash³

1999

Curr Cardiol Rep

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Implantable cardioverter defibrillators (ICDs) have proven highly successful in the treatment of recurrent ventricular and atrial arrhythmias. Despite their high efficacy in terminating arrhythmias, concomitant therapy with antiarrhythmic drugs in ICD recipients remains common. Antiarrhythmic drugs are employed in an attempt to to limit patient exposure to high-energy shocks, primarily by reducing the number of arrhythmia reccurrences, suppressing coexisting arrhythmias, affecting rate and organization of tachycardias, and increasing efficacy of painless pacing therapies. Data regarding interaction of antiarrhythmic drugs with ICDs are incomplete and mostly based on animal models; however, it is clear that antiarrhythmic drugs affect all aspects of function of devices such as defibrillation threshold, pacing threshold, and sensing of both atrial and and ventricular arrhythmias. Because significant change in any of these functions may result in a nonfunctional device, and magnitude of drug effect in an individual patient is unpredictable, careful assessment of ICD function after an institution of therapy with antiarrhythmic drugs is mandatory.

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Section: Antiarrhythmic Therapy In Recipients Of Implantable Cardiovementioning

confidence: 97%

Interactions of antiarrhythmic drugs with implantable defibrillator therapy for atrial and ventricular tachyarrhythmias

Król¹,

Saksena²,

Prakash³

1999

Curr Cardiol Rep

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“…Erste nichtrandomisierte Studien Anfangs der 90er Jahre [15,21] zeigten keine Reduktion der ICD-Schocks durch Antiarrhythmika inkl. Amiodaron.…”

Section: Verhinderung Von Häufigen Icd-therapienunclassified

Häufige ventrikuläre Tachykardie: Antiarrhythmika oder Ablation?

Tanner

Hindricks²,

Kottkamp

2005

Herz

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Antiarrhythmic drugs are used in at least 50% of patients who received an implantable cardioverter defibrillator (ICD). The potential indications for antiarrhythmic drug treatments in patients with an ICD are generally the following: reduction of the number of ventricular tachycardias (VTs) or episodes of ventricular fibrillation and therefore reduction of the number of ICD therapies, most importantly, the number of disabling ICD shocks. Accordingly, the quality of life should be improved and the battery life of the ICD extended. Moreover, antiarrhythmic drugs have the potential to increase the tachycardia cycle length to allow termination of VTs by antitachycardia pacing and reduction of the number of syncopes. In addition, supraventricular arrhythmias can be prevented or their rate controlled. Recently published or reported trials have shown the efficacy of amiodarone, sotalol and azimilide to significantly reduce the number of appropriate and inappropriate ICD shocks in patients with structural heart disease. However, the use of antiarrhythmic drugs may also have adverse effects: an increase in the defibrillation threshold, an excessive increase in the VT cycle length leading to detection failure. In this situation and when antiarrhythmic drugs are ineffective or have to be stopped because of serious side effects, catheter ablation of both monomorphic stable and pleomorphic and/or unstable VTs using modern electroanatomic mapping systems should be considered. The choice of antiarrhythmic drug treatment and the need for catheter ablation in ICD patients with frequent VTs should be individually tailored to specific clinical and electrophysiological features including the frequency, the rate, and the clinical presentation of the ventricular arrhythmia. Although VT mapping and ablation is becoming increasingly practical and efficacious, ablation of VT is mostly done as an adjunctive therapy in patients with structural heart disease and ICD experiencing multiple shocks, because the recurrence and especially the occurrence of "new" VTs after primarily successful ablation with time and disease progression have precluded a widespread use of catheter ablation as primary treatment.

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“…110 In two nonrandomized studies other antiarrhythmic drugs (sotalol was not tested) did not reduce the frequency of ICD discharge. 113,114 It is interesting that 16 of 33 patients in one of these studies were receiving amiodarone. 113 This is not consistent, however, with results of CASCADE, in which amiodarone significantly reduced the number of ICD discharges in a high-risk population.…”

Section: Implantable Cardioverter-defibrillators Versusmentioning

confidence: 99%

“…113,114 It is interesting that 16 of 33 patients in one of these studies were receiving amiodarone. 113 This is not consistent, however, with results of CASCADE, in which amiodarone significantly reduced the number of ICD discharges in a high-risk population. 90 It appears that, based on data from a limited number of studies, sotalol may be the most appropriate antiarrhythmic agent to be given in combination with ICDs.…”

Section: Implantable Cardioverter-defibrillators Versusmentioning

confidence: 99%

Role of Antiarrhythmic Therapy in Patients at Risk for Sudden Cardiac Death: An Evidence‐Based Review

Hilleman

Bauman

2001

Pharmacotherapy

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Sudden cardiac death (SCD) accounts for more than half of all cardiac deaths occurring each year in the United States. Although it has several causes, patients at greatest risk are those with coronary artery disease and impaired left ventricular function, heart failure secondary to ischemia or idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, documented sustained ventricular tachycardia or ventricular fibrillation, and survivors of cardiac arrest. The presence of asymptomatic ventricular arrhythmias, positive signal-averaged electrocardiogram (ECG), low heart rate variability index, or inducible ventricular tachycardia or ventricular fibrillation increases the risk. In primary prevention trials in patients with ischemic heart disease, beta-blockers reduced both total mortality and SCD, whereas class I antiarrhythmic drugs, especially class IC, increased mortality. Among class III agents, d,l-sotalol and dofetilide have a neutral effect on mortality, whereas d-sotalol increases mortality. Amiodarone has a neutral effect on total and cardiac mortality but does reduce the risk of arrhythmic death and cardiac arrest. Three primary prevention trials in patients with ischemic heart disease were conducted with implantable cardioverter-defibrillators (ICDs). Patients with low ejection fractions (EFs), asymptomatic ventricular arrhythmias, and inducible ventricular tachycardia or ventricular fibrillation had significant reductions in total, cardiac, and arrhythmic death with ICDs compared with either no drug therapy or conventional antiarrhythmic agents. The ICDs did not reduce mortality in patients with low EFs and a positive signal-averaged ECG undergoing coronary bypass graft. In those with heart failure, beta-blockers reduced total and SCD mortality, but dofetilide and amiodarone had a neutral effect on mortality. In the secondary prevention of SCD, antiarrhythmic drugs alone generally are not thought to improve survival. In three trials in patients with documented sustained ventricular tachycardia or ventricular fibrillation, or survivors of SCD, ICDs reduced cardiac and arrhythmic mortality. Total mortality, however, was significantly reduced in only one of these trials. The role of antiarrhythmic drugs in secondary prevention of SCD is limited to patients in whom ICD is inappropriate or in combination with ICD. Antiarrhythmics can be given selectively with ICDs to decrease episodes of ventricular tachycardia or fibrillation to reduce ICD discharges, to suppress episodes of nonsustained ventricular tachycardia that trigger ICD discharges, to slow the rate of ventricular tachycardia to increase hemodynamic stability, to allow effective antitachycardia pacing, or to suppress supraventricular arrhythmias.

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Effect of Antiarrhythmic Drug Therapy on the Incidence of Shocks in Patients who Receive an Implantable Cardioverter Defibrillator after a Single Episode of Sustained Ventricular Tachycardia/Fibrillation

Cited by 20 publications

References 8 publications

Interactions of antiarrhythmic drugs with implantable defibrillator therapy for atrial and ventricular tachyarrhythmias

Interactions of antiarrhythmic drugs with implantable defibrillator therapy for atrial and ventricular tachyarrhythmias

Häufige ventrikuläre Tachykardie: Antiarrhythmika oder Ablation?

Role of Antiarrhythmic Therapy in Patients at Risk for Sudden Cardiac Death: An Evidence‐Based Review

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