Excellent Long-Term Reproducibility of the Electrophysiologic Efficacy of Quinidine in Patients with Idiopathic Ventricular Fibrillation and Brugada Syndrome
Excellent Long-Term Reproducibility of the Electrophysiologic Efficacy of Quinidine in Patients with Idiopathic Ventricular Fibrillation and Brugada Syndrome
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DOI：
10.1111/j.1540-8159.2008.02235.x
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发表时间：
2009-03-01
影响因子：
1.8
通讯作者：
Viskin, Sami
中科院分区：
文献类型：
--
作者：
Belhassen, Bernard;Glick, Aharon;Viskin, Sami
背景：奎尼丁对特发性心室颤动和Brugada综合征患者在电生理研究（EPS）期间持续心室颤动（VF）的再诱导非常有效。然而，没有关于这种EP疗效的长期可重复性的数据。方法和结果：9例患者（7男2女，年龄21-72岁），因Brugada综合征（n = 5）或特发性VF （n = 4）发生心脏骤停流产（n = 8）或复发性晕厥（n = 1）。所有患者在基线时均有可诱导的持续性VF，可通过奎尼丁治疗预防，并在1.7-23.6（9.8 +/- 6.8）年（8例患者为50 - 5年）后再次接受药物治疗。2例患者在奎尼丁治疗后出现2次晚期EPS。奎尼丁重复EPS的目的是确保持续的长期药物疗效（n = 6）或阐明治疗期间晕厥发作的原因（n = 3）。多年来，随着其变得更具侵略性（更多起搏部位和/或更多心室外刺激），EPS方案显著发展。在长期随访期间（平均15 +/- 7年），所有9例患者对药物耐受良好，无复发性心律失常事件记录。任何患者在重复晚期EPS期间均未发生持续性室性心动过速。在6例患者中，可以在重复EPS中测试更积极的刺激方案。结论：奎尼丁治疗特发性VF合并Brugada综合征的EP疗效具有良好的长期重复性。在这些患者中，ep引导的奎尼丁治疗是ICD治疗的一个有价值的长期替代方案。[j]; 2009; 32:294-301。
Background: Quinidine is very effective in preventing the reinduction of sustained ventricular fibrillation (VF) during electrophysiologic study (EPS) in patients with idiopathic VF and Brugada syndrome. However, there are no data on the long-term reproducibility of this EP efficacy.Methods and Results: Nine patients (seven males and two females, aged 21-72 years), who suffered from aborted cardiac arrest (n = 8) or recurrent syncope (n = 1) due to Brugada syndrome (n = 5) or idiopathic VF (n = 4), comprised the study. All patients had inducible sustained VF at baseline that was prevented by quinidine therapy and underwent another EPS on medication after 1.7-23.6 (9.8 +/- 6.8) years (> 5 years in eight patients). Two patients underwent two late EPS on quinidine. The goal of repeat EPS on quinidine was to ensure persistent long-term drug efficacy (n = 6) or to elucidate the reason of syncopal episodes during therapy (n = 3). The EPS protocol significantly evolved over the years as it became more aggressive (more pacing sites and/or more ventricular extrastimuli). All nine patients tolerated the medication well and had no recurrent documented arrhythmic events during long-term follow-up (mean 15 +/- 7 years). No sustained ventricular tachyarrhythmias could be induced in any patient during repeat late EPS. In six patients, a more aggressive stimulation protocol could be tested at repeat EPS.Conclusion: The long-term reproducibility of the EP efficacy of quinidine in patients with idiopathic VF and Brugada syndrome is excellent. EP-guided quinidine therapy represents a valuable long-term alternative to ICD therapy in these patients.(PACE 2009; 32:294-301).