Day-to-day reproducibility of antiarrhythmic drug trials using programmed extrastimulus techniques for ventricular tachyarrhythmias associated with coronary artery disease

Kudenchuk, Peter J.; Kron, Jack; Walance, Charles G.; Cutler, Joel E.; Griffith, Karen; McAnulty, John H.

doi:10.1016/0002-9149(90)91138-v

Cited by 31 publications

(14 citation statements)

References 18 publications

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“…Two-thirds of the patients, in whom induction of ventricular tachycardia was suppressed by a study drug, responded to only one of the two class III antiarrhythmic agents. This finding may be interpreted in different ways: (1) dofetilide and sotalol may have a different effect on the same substrate due to their different electropysiological properties and the effect on ventricular effective refractory period was different; (2) programmed electrophysiological stimulation results in terms of efficacy, based on the adopted criteria, may not be strictly reproducible, as supported by some papers in literature [31,32] or (3) the underlying substrate for ventricular tachycardia may differ and thus respond to different drugs. In any case, the clinical implications of this finding are important since the trial demonstrates that the probability of detecting a positive response during programmed electrophysiological stimulation is increased by testing a second class III antiarrhythmic agent.…”

Section: Discussionmentioning

confidence: 93%

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

Boriani

Lubiński²,

Capucci³

et al. 2001

European Heart Journal

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Background Antiarrhythmic drugs are still used for the treatment of ventricular tachyarrhythmias, in combination with implantable cardioverter-defibrillators or without them.Aim of the study In a double-blind randomized crossover design, the short-and long-term efficacy and safety of oral dofetilide or oral sotalol were compared in 135 patients with ischaemic heart disease and inducible sustained ventricular tachycardia. MethodsThe inducibility of ventricular tachycardia was determined by programmed electrophysiological stimulation at baseline. Patients were then blindly randomized to receive either oral dofetilide 500 g twice daily or oral sotalol 160 mg twice daily, for 3 to 5 days. Suppression of inducible ventricular tachycardia on the drug was then assessed by programmed electrophysiological stimulation. After a wash-out period of at least 2·5 days, the patients received the alternative treatment for 3 to 5 days. Suppression of inducible ventricular tachycardia on the alternate drug was again determined by programmed electrophysiological stimulation. Selection of long-term treatment was allocated blindly according to programmed electrophysiological stimulation results.Results During the acute phase, 128 patients received both dofetilide and sotalol. Sixty-seven patients were responders to either drug. Forty-six patients (35·9%) were responders to dofetilide compared with 43 (33·6%) to sotalol (P=ns). Only 23 patients responded to both dofetilide and sotalol. Adverse events, deemed to be treatment related, were seen in 2·3% of patients receiving dofetilide and 8·6% of patients receiving sotalol (P=0·016). Three patients on dofetilide had torsade de pointes. Two patients receiving sotalol died during the acute phase (one was arrhythmic death, and the other was due to heart failure). During the long-term phase, two of 42 patients (4·8%) receiving dofetilide and three of 27 patients (11·1%) receiving sotalol withdrew from treatment due to lack of efficacy. Overall, during the long-term phase, 23·8% of the patients receiving dofetilide and 37·0% of the patients receiving sotalol, withdrew from treatment with a similar pattern of withdrawals for the two drugs.Conclusion Dofetilide was as efficacious as sotalol in preventing the induction of sustained ventricular tachycardia. There was no concordance in the response rate in two-thirds of the patients. Dofetilide was significantly better tolerated during the acute phase than sotalol. Both dofetilide and sotalol were well tolerated during the long term with no statistically significant difference in the adverse events.

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Section: Discussionmentioning

confidence: 93%

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

Boriani

Lubiński²,

Capucci³

et al. 2001

European Heart Journal

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“…First, changes in antiarrhythmic drugs are frequently made after ablation, particularly related to dosing or discontinuation of amiodarone. Second, the induction of re-entrant arrhythmias with programmed stimulation is probabilistic, and reproducibility is far from perfect (5). Third, changes in autonomic tone and/or the use of general anesthesia may affect VT inducibility (6,7).…”

Section: See Page 1536mentioning

confidence: 99%

Noninvasive Programmed Ventricular Stimulation Early After Ventricular Tachycardia Ablation to Predict Risk of Late Recurrence

Frankel

Mountantonakis

Zado

et al. 2012

Journal of the American College of Cardiology

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When patients with VT and structural heart disease have no VT or nonclinical VT only inducible at the end of ablation or their condition is too unstable to undergo final programmed stimulation, NIPS should be considered in the following days to further define risk of recurrence. If clinical VT is inducible at NIPS, repeat ablation may be considered because recurrence over the following year is high.

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“…29,30 The specific site of stimulation might also play a role; in this respect, LV stimulation has been demonstrated to be superior to right ventricular (RV) stimulation for inducing clinical VT in patients with ischemic cardiomyopathy. [31][32][33] Of note, the only study included in the pooled analysis that adopted LV stimulation was that by Carbucicchio et al 7 ; this study also reported 1 of the strongest associations between noninducibility at PES and long-term freedom from recurrent VT.…”

Section: Invasive Pesmentioning

confidence: 99%

“…In addition, longitudinal evaluations with repeated PES increase the chances of inducing VT, as shown in early studies adopting PES to guide antiarrhythmic drug therapy. 29,30 Based on these premises, our group has recently tested the hypothesis that repeat programmed stimulation through implantable cardioverter-defibrillator devices (ie, noninvasive PES [NIPS]) a few days after the ablation procedure might provide additional prognostic information. 38 …”

Section: Limitations Of Invasive Pes As An End Pointmentioning

confidence: 99%

End Points for Ablation of Scar-Related Ventricular Tachycardia

Frankel

Marchlinski

2014

Circ: Arrhythmia and Electrophysiology

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T he goal of catheter ablation strategies for the treatment of scar-related ventricular tachycardia (VT) is the interruption of critical areas of slow conduction within the VT circuits responsible for the development and maintenance of VTs. 1,2 Clinical studies have consistently shown the superiority of radiofrequency catheter ablation compared with standard medical therapy in controlling recurrent VT. 3,4 However, even after an acutely successful ablation, the long-term freedom from recurrent VT remains suboptimal, especially in patients with nonischemic substrates where the recurrence rates for longterm follow-up can be as high as 77%.5 Identification of the optimal end points for VT ablation is crucial to improve the success rate of this procedure. The response to programmed electric stimulation (PES) at the end of the procedure has been traditionally used to evaluate the acute success and predict longterm outcomes.1,2 Noninducibility by PES represents a classical end point for VT ablation and the only 1 endorsed by the current practice guidelines.1,2 Of note, a direct association between VT noninducibility at the end of the procedure and long-term arrhythmia-free survival has been suggested but not uniformly demonstrated. 4,[6][7][8][9] More recently, the increasing adoption of substrate-based ablation techniques, which target specific electrograms indexing slow conduction (ie, abnormal, split, and late electrograms) in sinus rhythm and reasonable surrogates for the VT isthmus, 10,11 has been paralleled by an increasing need for new ablation end points. Although noninducibility at PES has been used as an end point also in studies evaluating substratebased ablation approaches, other procedural end points have been described to validate the completeness of linear lesions and the elimination of abnormal potentials within the scar. This review will summarize the state of the art regarding procedural end points for catheter ablation of scar-related VT (Table 1). Invasive PESNoninducibility at PES represents the most widely accepted end point for catheter ablation of scar-related VT. The most recent expert consensus document on VT ablation endorses noninducibility of the presumed clinical VT as the minimum end point for catheter ablation of scar-related VT; other end points beyond noninducibility are discussed but not specifically endorsed, because they have not been systematically validated.1,2 The bulk of the evidence supporting noninducibility at PES as a procedural end point derives from studies including patients with infarct-related VT (Table 2). Early experiences with catheter ablation in this clinical setting reported a significant association between noninducibility at the end of the procedure and VT-free survival.12-16 Subsequent studies including larger patient populations have provided mixed results. 4,6,7,9,12,13,15,[17][18][19][20][21][22][23][24][25][26][27] It is important to emphasize that none of these studies was specifically designed to perform a formal longitudinal evaluation of noninducibili...

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Day-to-day reproducibility of antiarrhythmic drug trials using programmed extrastimulus techniques for ventricular tachyarrhythmias associated with coronary artery disease

Cited by 31 publications

References 18 publications

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

Noninvasive Programmed Ventricular Stimulation Early After Ventricular Tachycardia Ablation to Predict Risk of Late Recurrence

End Points for Ablation of Scar-Related Ventricular Tachycardia

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