Interactions between drugs and devices: Experimental and clinical studies

Manz, M; Jung, Werner; Lüderitz, Berndt

doi:10.1016/0002-8703(94)90076-0

Cited by 62 publications

(27 citation statements)

References 30 publications

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“…From previous studies, we know that amiodarone increases the DFT [26, 27, 28]and thus potentially reduces the effectiveness of a PCD in terminating malignant ventricular arrhythmias. Some class III anti-arrhythmic agents, such as sotalol, have been shown to decrease DFT, while class I agents have the opposite effects [10]. Studies of DFT in pure class III anti-arrhythmic drugs suggest an inverse relationship between the prolonged refractory stage from potassium channel blockade and the amount of energy required to overcome the fibrillation [9].…”

Section: Discussionmentioning

confidence: 99%

“…Conventional drug therapy is used in these individuals to decrease the frequency of spontaneous ventricular tachyarrhythmias, slow the rate of the ventricular tachycardia once breakthrough occurs, suppress supraventricular tachy-arrhythmias (SVT) and lower the ventricular response if the SVT is non-suppressible. Most importantly, concomitant anti-arrhythmic therapy in patients with a PCD is also thought to reduce the incidence of PCD shocks and thus minimize patient discomfort [10]. …”

Section: Introductionmentioning

confidence: 99%

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Shocks from Pacemaker Cardioverter Defibrillators Increase with Amiodarone in Patients at High Risk for Sudden Cardiac Death

Shinde

Juneman²,

Mitchell

et al. 2003

Cardiology

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The efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) to decrease episodes of ventricular tachycardia and subsequent PCD shocks is not clear. We examined a retrospective registry of 82 patients with PCD implantation to define the efficacy of amiodarone treatment. We compared patients treated with amiodarone (for 24 consecutive months without interruption) versus no amiodarone. In patients treated with amiodarone there was a 3-fold increase (p = 0.02) in PCD shocks; in patients not on beta-blockers, amiodarone resulted in a 6-fold increase (p < 0.05) in PCD shocks. Patients with a left ventricular ejection fraction >30% on amiodarone and patients <72 years old had increases (p < 0.05) in PCD shocks. In conclusion, patients treated with amiodarone had more PCD shocks than those not treated. These findings are unexpected and merit a prospective study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Shocks from Pacemaker Cardioverter Defibrillators Increase with Amiodarone in Patients at High Risk for Sudden Cardiac Death

Shinde

Juneman²,

Mitchell

et al. 2003

Cardiology

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“…Amiodarone appears to have a less consistent effect [41,42]; however, in selected individuals, it appears to be associated with potentially life-threatening increase in defibrillation threshold when administered chronically [43][44][45][46]. The Low Energy Safety Study [47] assessed the efficacy and safety of programming chronic ICD shock energy levels based on defibrillation threshold.…”

Section: Antiarrhythmic Drugs Causing Increase In Defibrillation Thrementioning

confidence: 99%

Interactions of antiarrhythmic drugs and implantable devices in controlling ventricular tachycardia and fibrillation

et al. 2002

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Implantable cardioverter defibrillators (ICDs) have proven highly successful in the treatment of life-threatening ventricular arrhythmias. Despite the efficacy of the ICD in terminating ventricular arrhythmias, antiarrhythmic drugs remain an important adjunct to ICD therapy. The use of antiarrhythmic drug therapy in combination with the ICD is synergistic in terms of beneficial effects, but also has the potential for some adverse interactions. Knowledge and recognition of these potential interactions is important for any physician managing patients with an ICD. This review summarizes the benefits and adverse effects of ICD in combination with antiarrhythmic drug therapy, and provides guidelines to ensure safe application of this hybrid therapy.

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“…The data on the effects of antiarrhythmic drugs on defibrillation thresholds are incomplete, and often largely based on animal data, which may be species specific and have limited extrapolation to humans. Different results have often been obtained with different animal models, ie, dogs and pigs, employing different kinds of anesthesia (Table 1) [31,[36][37][38][39][40][41][42][43][44][45][46]. In a prospective parallel design human study, long-term therapy with mexiletine had no effect on defibrillation thresholds [46]; more recent data dispute this suggesting that mexiletine may elevate defibrillation threshold even more than amiodarone [47].…”

Section: Defibrillation Therapiesmentioning

confidence: 99%

Interactions of antiarrhythmic drugs with implantable defibrillator therapy for atrial and ventricular tachyarrhythmias

Król¹,

Saksena²,

Prakash³

1999

Curr Cardiol Rep

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Implantable cardioverter defibrillators (ICDs) have proven highly successful in the treatment of recurrent ventricular and atrial arrhythmias. Despite their high efficacy in terminating arrhythmias, concomitant therapy with antiarrhythmic drugs in ICD recipients remains common. Antiarrhythmic drugs are employed in an attempt to to limit patient exposure to high-energy shocks, primarily by reducing the number of arrhythmia reccurrences, suppressing coexisting arrhythmias, affecting rate and organization of tachycardias, and increasing efficacy of painless pacing therapies. Data regarding interaction of antiarrhythmic drugs with ICDs are incomplete and mostly based on animal models; however, it is clear that antiarrhythmic drugs affect all aspects of function of devices such as defibrillation threshold, pacing threshold, and sensing of both atrial and and ventricular arrhythmias. Because significant change in any of these functions may result in a nonfunctional device, and magnitude of drug effect in an individual patient is unpredictable, careful assessment of ICD function after an institution of therapy with antiarrhythmic drugs is mandatory.

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Interactions between drugs and devices: Experimental and clinical studies

Cited by 62 publications

References 30 publications

Shocks from Pacemaker Cardioverter Defibrillators Increase with Amiodarone in Patients at High Risk for Sudden Cardiac Death

Shocks from Pacemaker Cardioverter Defibrillators Increase with Amiodarone in Patients at High Risk for Sudden Cardiac Death

Interactions of antiarrhythmic drugs and implantable devices in controlling ventricular tachycardia and fibrillation

Interactions of antiarrhythmic drugs with implantable defibrillator therapy for atrial and ventricular tachyarrhythmias

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