Antiarrhythmic Efficacy of Dipyridamole in Treatment of Reperfusion Arrhythmias

Abstract

Background-Intracellular calcium overload is believed to play an important role in development of reperfusion arrhythmias. Dipyridamole, an inhibitor of cellular uptake of adenosine, may prevent or terminate reperfusion arrhythmias by reducing intracellular calcium overload. Methods and Results-First, we tested for a preventive effect of dipyridamole. Sixty-one patients who underwent primary PTCA for treatment of acute anterior wall myocardial infarction were enrolled in this prospective study. Patients were divided into dipyridamole (DP) and nondipyridamole (non-DP) groups. The 2 groups had similar baseline characteristics. In the DP group, dipyridamole 0.5 mg/kg was infused intravenously for 3 minutes immediately before reperfusion during primary PTCA. Arrhythmias after reperfusion were analyzed from continuous ECG recordings. None of the patients in the DP group (nϭ23) had accelerated idioventricular rhythms (AIVR) or ventricular tachycardia (VT). In contrast, 7 (18.4%) had AIVR and 3 (7.9%) had VT in the non-DP group (nϭ38; PϽ0.01). Second, we tested for a termination effect of dipyridamole. Dipyridamole 0.5 mg/kg was infused intravenously while continuous ECG recordings were obtained in 9 patients who had either sustained AIVR (nϭ7) or sustained VT (nϭ2) after reperfusion of occluded coronary artery. Arrhythmias were terminated in all patients. Conclusions-These results indicate that administration of dipyridamole can prevent and terminate reperfusion arrhythmias such as AIVR and VT. cAMP-mediated triggered activity may, at least in part, be responsible for reperfusioninduced AIVR and VT. (Circulation. 2000;101:624-630.)

Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data

“…In a canine model of hypothermia, dipyridamole is thought to mediate such effect (110) and reduced the core temperature of which dogs would go into VF (111).…”

Dipyridamole with Low-Dose Aspirin Augments the Infarct Size-Limiting Effects of Simvastatin

“…Furthermore, intracoronary DIP reduced the incidence of adverse cardiovascular events in the first 48 h after balloon angioplasty of small coronary arteries [7]. Yoshida and colleagues [8] also reported that intracoronary DIP administered for acute anterior wall MI before primary percutaneous coronary intervention prevented reperfusion arrhythmia. However, in a study by Thompson and colleagues [9], 202 patients with ST-segment elevation myocardial infarction (STEMI) who were randomly assigned to receive either a continuous intravenous heparin infusion or oral DIP (100 mg, 3 times a day) and ASA (300 mg/d) 24 h after thrombolytic therapy had similar outcomes.…”

Equilibrative nucleoside transporters—A review

“…Adenosine is of particular interest because of its wide-ranging effects on multiple organ systems by interacting with adenosine receptors Adora1, Adora2a, Adora2b, and Adora3 (1, 18, 19) which govern cellular functions via regulation of downstream heterotrimeric G-proteins (20, 21). ENTs also modulate efficacy for a chemically diverse range of therapeutics (>30 FDA/EMA approved drugs) including anticancer (e.g., gemcitabine, cytarabine) (22), antiarrhythmia (e.g., dilazep, dipyridamole) (23, 24), antiviral (e.g., ribavirin, azidothymidine) (25–27), and antihypertensive (e.g., nifedipine) (28, 29) medications (Figure 1). However, medications that exert their effects in the cardiovasuclar (e.g., dilazep, dipyridamole, nifedipine) system are known to have overlapping functions and can affect vasodilation (33–36) as well as platelet activity (37–40).…”