Effect of empiric antiarrhythmic therapy in resuscitated out-of-hospital cardiac arrest victims with coronary artery disease

Abstract

The effect of empiric antiarrhythmic therapy with quinidine and procainamide on long-term mortality was examined in 209 patients with coronary artery disease resuscitated after out-of-hospital cardiac arrest. The antiarrhythmic agent used was determined by the patient's private physician without knowledge of the study ambulatory electrocardiogram. Of the 209 patients, procainamide was prescribed in 45 (22%), quinidine in 48 (23%) and no antiarrhythmic therapy in 116 (55%). Digoxin therapy was initiated in 101 patients. The 2-year total survival rate for the quinidine, procainamide and nontreated patients was 61, 57 and 71% (p less than 0.05), and for sudden death was 69, 69 and 89% (p less than 0.01), respectively. These observations suggest that empiric antiarrhythmic therapy in survivors of out-of-hospital cardiac arrest did not affect total mortality and was associated with an increased frequency of sudden death.

Comparison of the Effect of Class IA Antiarrhythmic Drugs on Transmembrane Potassium Currents in Rabbit Ventricular Myocytes

“…When initiated during continuous monitoring, early proarrhythmia with procainamide is rare (51). When used empirically as treatment after cardiac arrest, procainamide was associated with an increased sudden-death rate compared with untreated patients (50).…”

Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest

“…The univariate hazard ratio for treatment with β blockers in the present series was 0.46 (95% confidence interval 0.30 to 0.70), but β blockade was not a significant independent factor in the proportional hazards analysis. The low usage of class I antiarrhythmic drugs compared with previous series may have protected patients from the lethal proarrhythmic effects of these drugs which have been identified in recent years 13 15 16 17…”

“…The use of empirical class I antiarrhythmic agents is associated with an increase in mortality13 14 15 and even antiarrhythmic treatment guided by electrophysiological testing seems no better than empirical β blockade24 and is inferior to amiodarone 25. The implantable cardioverter defibrillator is commonly used in the United States for this type of patient26 and seems to reduce the risk of sudden death, although its effects on overall survival are less impressive27 and await confirmation in clinical trials currently under way 28 29…”

Treatment of Ventricular Arrhythmias in the Elderly

“…The 2-year sudden death survival was 69% for quinidine-treated patients, 69% for procainamidetreated patients, and 89% for patients treated with no antiarrhythmic drug (P Ͻ 0.01). 50 The 2-year total survival was 61% for quinidinetreated patients, 57% for procainamide-treated patients, and 71% for patients treated with no antiarrhythmic drug (P Ͻ 0.05). 50 Hallstrom et al 51 performed a retrospective analysis of the effect of antiarrhythmic drug use in 941 patients, mean age 62 years, resuscitated from prehospital cardiac arrest attributable to VF between 1970 and 1985.…”

“…50 The 2-year total survival was 61% for quinidinetreated patients, 57% for procainamide-treated patients, and 71% for patients treated with no antiarrhythmic drug (P Ͻ 0.05). 50 Hallstrom et al 51 performed a retrospective analysis of the effect of antiarrhythmic drug use in 941 patients, mean age 62 years, resuscitated from prehospital cardiac arrest attributable to VF between 1970 and 1985. Quinidine was administered to 19% of the patients, procainamide to 18% of the patients, beta-blockers to 28% of the patients, and no antiarrhythmic drug to 39% of the patients.…”