Efficacy of disopyramide and mexiletine used alone or in combination in the treatment of ventricular premature beats

Sakurada, Harumizu; Motomiya, Takeshi; Hiraoka, Masayasu

doi:10.1007/bf00120832

Cited by 6 publications

(1 citation statement)

References 11 publications

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“…9) Previous reports have described combination therapy with class Ia and class Ib agents 10,11) and most of these reports indicate the superiority of these combination therapies. [12][13][14] DP+MX is one of the most frequently used combination. The present study also clearly showed the synergistic effect of DP+ MX in treating PVC.…”

Section: Influence Of Individual Antiarrhythmic Drugs On Saecg Paramementioning

confidence: 99%

Acute Effects on Signal-Averaged Electrogram Parameters and Suppressing Premature Ventricular Contractions in Single or Combined Use of Class I Antiarrhythmic Drugs

et al. 2006

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Disopyramide (DP), mexiletine (MX), and flecainide (FL) are class I antiarrhythmic drugs. However, these drugs exert different effects on the electrocardiogram (ECG) based on their unique actions on cardiac myocytes. The electrocardiographic changes during combination therapy with these drugs are not well understood. The purpose of the present study was to evaluate acute morphologic changes in the ECG based on signal-averaged high resolution ECG (SAECG) after administration of the drugs in relation to their antiarrhythmic efficacy and safety. Twenty-one patients with frequent and stable premature ventricular contractions (PVC) were studied. Changes in the filtered QRS duration (f-QRS) and the root mean square voltage of the last 40 msec of the QRS complex (RMS40) were evaluated. Suppression of PVCs was achieved soon after intravenous administration of the drugs (63% for DP, 43% for MX, 86% for FL and 100% for DP+MX). Although DP and FL significantly prolonged f-QRS, MX had little effect on f-QRS. DP+MX also prolonged f-QRS, but the degree of prolongation was moderate. RMS40 was significantly decreased by DP and FL, but not by MX. DP+MX also decreased RMS40, but the decrease was less than for DP alone. Late potentials were observed after administration in 56% of patients with DP, 0% with MX, 67% with FL and 0% with DP+MX. No adverse events were reported during the study.In summary, the class I antiarrhythmic drugs exerted different acute effects on SAECG parameters. The combination of DP and MX increased the efficacy on suppressing PVC without excess additive changes on SAECG parameters. We conclude that combination therapy with DP and MX is efficacious and safe in patients with PVC and the analysis of SAECG during antiarrhythmic therapy is clinically important. (J Arrhythmia 2006; 22: 155-160)

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Section: Influence Of Individual Antiarrhythmic Drugs On Saecg Paramementioning

confidence: 99%

Acute Effects on Signal-Averaged Electrogram Parameters and Suppressing Premature Ventricular Contractions in Single or Combined Use of Class I Antiarrhythmic Drugs

et al. 2006

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Polypharmacology in Clinical Applications: Cardiovascular Polypharmacology

Wang

Yang²

2022

Polypharmacology

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Relevance of mexiletine in the era of evolving antiarrhythmic therapy of ventricular arrhythmias

Alhourani,

Wolfes,

Könemann

et al. 2024

Clin Res Cardiol

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Despite impressive developments in the field of ventricular arrhythmias, there is still a relevant number of patients with ventricular arrhythmias who require antiarrhythmic drug therapy and may, e.g., in otherwise drug and/or ablation refractory situations, benefit from agents known for decades, such as mexiletine. Through its capability of blocking fast sodium channels in cardiomyocytes, it has played a minor to moderate antiarrhythmic role throughout the recent decades. Nevertheless, certain patients with structural heart disease suffering from drug-refractory, i.e., mainly amiodarone refractory ventricular arrhythmias, as well as those with selected forms of congenital long QT syndrome (LQTS) may nowadays still benefit from mexiletine. Here, we outline mexiletine’s cellular and clinical electrophysiological properties. In addition, the application of mexiletine may be accompanied by various potential side effects, e.g., nausea and tremor, and is limited by several drug-drug interactions. Thus, we shed light on the current therapeutic role of mexiletine for therapy of ventricular arrhythmias and discuss clinically relevant aspects of its indications based on current evidence. Graphical abstract

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Efficacy of disopyramide and mexiletine used alone or in combination in the treatment of ventricular premature beats

Cited by 6 publications

References 11 publications

Acute Effects on Signal-Averaged Electrogram Parameters and Suppressing Premature Ventricular Contractions in Single or Combined Use of Class I Antiarrhythmic Drugs

Acute Effects on Signal-Averaged Electrogram Parameters and Suppressing Premature Ventricular Contractions in Single or Combined Use of Class I Antiarrhythmic Drugs

Polypharmacology in Clinical Applications: Cardiovascular Polypharmacology

Relevance of mexiletine in the era of evolving antiarrhythmic therapy of ventricular arrhythmias

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