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

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

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Forty-nine patients with coronary artery disease and documented clinical sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) were studied twice in the drug-free state and twice during treatment with an identical antiarrhythmic medication at therapeutic plasma concentrations using an identical programmed electrical stimulation protocol. Tested drugs included procainamide, quinidine, disopyramide and phenytoin. During their 2 paired tests, 11 patients had nearly identical therapeutic plasma concentrations of antiarrhythmic agents (group I) and 38 patients had therapeutic plasma concentrations, but with more variation in drug levels between otherwise identical paired drug tests (group II). Overall, 71% of patients had inducible sustained VT or VF during drug testing. Induced ventricular arrhythmias were not reproducible in 45% of group I patients, despite restudy at nearly identical therapeutic plasma concentrations of an identical antiarrhythmic agent. Induced arrhythmias were also not reproducible in 16% of group II patients. This variability could not be attributed to the electrophysiologic characteristics of the patients studied. Drug trials directed by programmed stimulation should be cautiously interpreted because time-associated changes can mimic a change attributed to a beneficial or deleterious drug effect.

Original languageEnglish (US)
Pages (from-to)725-730
Number of pages6
JournalThe American Journal of Cardiology
Volume66
Issue number7
DOIs
StatePublished - Sep 15 1990

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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