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

Abstract

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.

Effect of Concomitant Antiarrhythmic Therapy on Survival in Patients with Implantable Cardioverter Defibrillators

“…In many cases, these agents are used to control or reduce ventricular and supraventricular arrhythmias 7 . Specific drug‐device interactions have also been reported 7–9 . Although the survival effects of antiarrhythmic drugs on the non‐ICD patient population have been well described, what is not clear is how these drugs affect survival in patients with ICDs.…”

“…7 Specific drug-device interactions have also been reported. [7][8][9] Although the survival effects of antiarrhythmic drugs on the non-ICD patient population have been well described, what is not clear No financial associations with a third party to disclose. is how these drugs affect survival in patients with ICDs.…”