Is Quinidine of Value in the Treatment of Auricular Fibrillation?

Abstract

In the past few years numerous reports of the results of the use of quinidine sulphate in the treatment of auricular fibrillation have appeared from various parts of the world. It is not our purpose here to review the literature on the subject but rather to place on record our experiences.Considerable enthusiasm has been expressed by many, as would naturally be expected of a new drug that promised help in the treatment of any chronic disease. It has occurred to us from the start that much of the enthusiasm was unwarranted, both from a theoretical point of view and now as a result of studying thirtyeight cases of auricular fibrillation treated in the Peter Bent Brigham Hospital.The cardinal symptom of most patients suffering from heart disease is dyspnoea, and where auricular fibrillation is an added feature in the case, palpitation as a result of the rapid irregular heart action is also a frequent complaint. The mechanism of these two symptoms is different and has different origins. Dyspnoea improves or grows worse as the efficiency of the circulation changes. Palpitation on the other hand depends on the nervous state of the patient, whether the heart is regular or irregular, the actual rate of the heart and other factors. Palpitation may exist when the circulation is satisfactory or there may be no palpitation even when dyspnoea is extreme. It therefore follows that in judging any improvement of the efficiency of the circulation one should follow particularly the changes that indicate improvement in the signs of congestive failure and especially the complaint of dyspnoea. Clinically, the vital capacity of the lungs varies quite closely with the improvement in the signs of congestive heart failure and therefore such determinations were made in this study with the hope of finding out what value quinidine sulphate might have in patients with auricular fibrillation.A study of thirty-eight patients was made of whom thirty-seven had persistent auricular fibrillation and one had auricular flutter. There were sixteen males and twenty-two were females.The ages ranged from fifteen to seventy-eight. There were two general groups, those with mitral stenosis of which there were twenty-three and those with chronic, myocarditis without valve disease of which there were fifteen. Most of the patients gave evidence of more or less congestive heart failure although some were almost free from all symptoms and were admitted to the wards with the purpose of trying the effect of quinidine.All the patients were put to bed and kept under careful observation. They were treated in the customary way, being given digitalis in full doses unless they were already well compensated or well digitalized. The purpose was to get whatever improvement was possible by all the other means available and then to try quinidine sulphate in order to be able to decide that if an improvement occurred it was due to the quinidine and not to the other measures used.The quinidine was usually administered in the following way. First 0.2 gram was given twice a day ...