Skip to main content

Ventricular Tachycardia and Fibrillation: Pharmacologic Therapy

  • Chapter
  • First Online:
Management of Cardiac Arrhythmias

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

This chapter reviews the clinical pharmacology, electrophysiology, efficacy and safety, and current recommendations of use of class IA, IB, IC, II, and III antiarrhythmic agents in the acute and chronic treatment of ventricular tachycardia. In addition, the role of these drugs in patients with implantable cardioverter-defibrillators is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Vaughn Williams EM (1984) A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 24:129–147

    Google Scholar 

  2. Task Force of the Working Group on Arrhythmias of the European Society of Cardiology (1991) The Sicilian Gambit. A new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. Circulation 84:1831–1851

    Article  Google Scholar 

  3. Fromm MF, Kim RB, Stein CM et al (1999) Inhibition of P-glycoprotein-mediated drug transport: A unifying mechanism to explain the interaction between digoxin and quinidine. Circulation 99:552–557

    Article  PubMed  CAS  Google Scholar 

  4. Salerno DM (1988) Review: Antiarrhythmic drugs; 1987. Part I-J Electrophysiology l:217, 1987; Part II-1:300–319, 1987, Part III-1:435–465, 1987; Part IV-2:55–87

    Google Scholar 

  5. DiMarco JP, Garan H, Ruskin JN (1983) Quinidine for ventricular arrhythmias. Value of electrophysiologic testing. Am J Cardiol 51:90–95

    Article  PubMed  CAS  Google Scholar 

  6. Mason JW and the ESVEM Investigators (1993) A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. N Engl J Med 329:452–458

    Article  PubMed  CAS  Google Scholar 

  7. Duff HJ, Kolodgie FD, Roden DM, Woosley RL (1986) Electropharmacologic synergism with mexiletine and quinidine. J Cardiovasc Pharmacol 8:840–846

    PubMed  CAS  Google Scholar 

  8. Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, Gussak I, LeMarec H, Nademanee K, Perez Riera AR, Shimizu W, Schulze-Bahr E, Tan H, Wilde A (2005) Brugada syndrome: report of the second consensus conference. Endorsed by the heart rhythm society and the European heart rhythm association. Circulation 111:659–670

    Article  PubMed  Google Scholar 

  9. Flaker GC, Blackshear JL, McBride R et al (1992) Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. J Am Coll Cardiol 20:527–532

    Article  PubMed  CAS  Google Scholar 

  10. Greenspan AM, Horowitz LN, Spielman SR, Josephson ME (1980) Large-dose procainamide therapy for ventricular tachyarrhythmia. Am J Cardiol 46:453–462

    Article  PubMed  CAS  Google Scholar 

  11. Waxman HL, Buxton AE, Sadowski LM, Josephson ME (1982) Resposne to procainamide during electrophysiologic study for sustained ventricular tachycardia predicts response to other drugs. Circulation 67:30–37

    Article  Google Scholar 

  12. ACLS-The Reference Textbook (2003) Cummins RO (ed), Field JM, Hazinski MF (associate eds), ACLS principles and practice, pp 57–70

    Google Scholar 

  13. Gorgels APM, van den Dool A, Hofs A, Mullenerrs R, Smeets JLRM, Vos MA, Wellens HJJ (1996) Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. Am J Cardiol 78:43–46

    Article  PubMed  CAS  Google Scholar 

  14. Lermann BB, Waxman HL, Buxton AE, Josephson ME (1983) Disopyramide: evaluation of electrophysiologic effects and clinical efficacy in patients with sustained ventricular tachycadia or ventricular fibrillation. Amer J Cardiol 51:759–764

    Article  Google Scholar 

  15. Podrid PJ, Schoeneberger A, Lown B (1980) Congestive heart failure caused by oral disopyramide. N Engl J Med 302:614–617

    Article  PubMed  CAS  Google Scholar 

  16. Roden DM, Woosley RL, Primm K (1986) Incidence and clinical features of the quinidine-associated long QT syndrome: implications for patient care. Am Heart J 111:1088–1093

    Article  PubMed  CAS  Google Scholar 

  17. Grant AO, Wendt DJ (1991) Blockade of ion channels by antiarrhythmic drugs. J Cardiovasc Electrophysiol 2: 5153–5158

    Google Scholar 

  18. Collingsworth KA, Kalman SN, Harrison DC (1974) The clinical pharmacology of lidocaine as an antiarrhythmic drug. Circulation 50:1217–1230

    Article  Google Scholar 

  19. Harrison DC (1975) Practical guidelines for the use of lidocaine. Prevention and treatment of cardiac arrhythmias. JAMA 233:1202–1204

    Article  PubMed  CAS  Google Scholar 

  20. Hine LK, Laird N, Hewitt P et al (1989) Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction. Arch Intern Med 149:2694–2698

    Article  PubMed  CAS  Google Scholar 

  21. Lie KI, Wellens HJJ, VanCapelle FJ, Durrer D (1974) Lidocaine in the prevention of ventricular fibrillation. N Engl J Med 291:1324–1326

    Article  PubMed  CAS  Google Scholar 

  22. Herlitz J, Ekstrom L, Wennerblom B, Axelsson A, Bang A, Lindkvist J, Persson NG, Holmberg S (1997) Lidocaine in out-of-hospital ventricular fibrillation. Does it improve survival? Resuscitation 33:199–205

    Article  CAS  Google Scholar 

  23. Kowey PR, Levine JH, Herre JM, Pacifico A, Lindsay BD, Plumb VJ, Janosik DL, Kopelman HA, Scheinman MM (1994) Randomized, double-blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent, hemodynamically destabilizing ventricular tachycardia or fibrillation. The intravenous amiodarone multicenter investigators group. Circulation 92:3255–3263

    Article  Google Scholar 

  24. Haynes RE, Chinn TL, Capass MK, Cobb LA (1981) Comparison of bretylium tosylate and lidocaine in management of out-of-hospital ventricular fibrillation. A randomized clinical trial. Am J Cardiol 48:353–356

    Article  PubMed  CAS  Google Scholar 

  25. Weaver WD, Fahrenbruch CE, Johnson DD, Hallstrom AP, Cobb LA, Copass MK (1990) Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation. Circulation 82:2027–2034

    Article  PubMed  CAS  Google Scholar 

  26. Thompson PD et al (1973) Lidocaine pharmcokinetics in advanced heart failure, liver disease and renal failure in humans. Ann Int Med 78:499–508

    Google Scholar 

  27. Campbell RWF (1987) Mexiletine. N Engl J Med 316:29–34

    Article  PubMed  CAS  Google Scholar 

  28. Impact Research Group (1984) International mexiletine and placebo antiarrhythmic coronary trial. I. Report on arrhythmia and other findings. J Am Coll Cardiol 4:1148–1163

    Article  Google Scholar 

  29. DiMarco JP, Garan H, Ruskin JN (1981) Mexiletine for refractory ventricular arrhythmias: Results using serial electrophysiologic testing. Am J Cardiol 47:131–140

    Article  PubMed  CAS  Google Scholar 

  30. Berns E, Naccarelli GV, Dougherty AH, Povia C, Rinkenberger RL (1988) Mexiletine: Lack of predictors of clinical response in patients treated for life-threatening tachyarrhythmias. J Electrophysiol 2:201–206

    Google Scholar 

  31. Garson A, Randall DC, Gillette PC, Smith RT, Moak JP, McVey JP, McNamara DG (1985) Prevention of sudden death after repair of Tetralogy of Fallot: treatment of ventricular arrhythmias. J Am Coll Cardiol 6:221–227

    Article  PubMed  Google Scholar 

  32. Ruan Y, Liu N, Bloise R, Napolitano C, Prior SG (2007) Gating properties of SCN5A mutations and the response to mexiletine in long-QT syndrome type 3 patients. Circulation 116:1137–1144

    Article  PubMed  CAS  Google Scholar 

  33. Roden DM, Woosley RL (1986) Drug therapy: flecainide. N Engl J Med 315:36–41

    Article  PubMed  CAS  Google Scholar 

  34. The Cardiac Arrhythmia Suppression Trial Investigators (1989) Preliminary report: Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321:406–412

    Article  Google Scholar 

  35. Flecainide ventricular tachycardia study group (1986) Treatment of resistant ventricular tachycardia with flecainide acetate. Amer J Cardiol 57:1299–1304

    Article  Google Scholar 

  36. Gill JS, Mehta D, Ward DE, Camm AJ (1992) Efficacy of flecainide, sotalol, and verapamil in the treatment of right ventricular tachycardia in patients without overt cardiac abnormality. Br Heart J 68:392–397

    Article  PubMed  CAS  Google Scholar 

  37. Podrid PJ, Lown B (1984) Propafenone: a new agent for ventricular arrhythmias. J Am Coll Cardiol 4:117–125

    Article  PubMed  CAS  Google Scholar 

  38. Connally SJ, Kates RE, Lebsack CS, Harrison DC, Winkle RA (1983) Clinical pharmacology of propafenone. Circulation 68:589–596

    Article  Google Scholar 

  39. Siddoway LA, Thompson EA, McAllister CB et al (1987) Polymorphism propafenone metabolism and disposition in man: clinical and pharmacokinetic consequences. Circulation 75:785–791

    Article  PubMed  CAS  Google Scholar 

  40. Naccarella F, Bracchetti D, Palmieri M, Cantinelli I, Bertaccini P, Ambrosioni E (1985) Comparison of propafenone and disopyramide for treatment of chronic ventricular arrhythmias: placebo-controlled, double-blind, randomized crossover study. Am Heart J 109:833–839

    Article  PubMed  CAS  Google Scholar 

  41. Chilson DA, Heger JJ, Zipes DP, Browne KF, Prystowsky EN (1985) Electrophysiologic effects and clinical efficacy of oral propafenone therapy in patients with ventricular tachycardia. J Am Coll Cardiol 5:1407

    Article  PubMed  CAS  Google Scholar 

  42. Siebels J, Cappato R, Ruppel R, Schneider MAE, Kuck KH, and the CASH Investigators (1993) Preliminary results of the cardiac arrest study hamburg (CASH). Am J Cardiol 72:109F–113F

    Article  PubMed  CAS  Google Scholar 

  43. Naccarelli GV, Wolbrette DL, Dell’Orfano JT, Patel HM, Luck JC (1998) A decade of clinical trial developments in postmyocardial infarction, congestive heart failure, and sustained ventricular tachyarrhymia patients: from CAST to AVID and beyond. J Cardiovasc Electrophysiol 9:864–891

    Article  PubMed  CAS  Google Scholar 

  44. Singh SN, DiBianco R, Davidson ME, Gottdeiner JS, Johnson WL, Laddu AR, Fletcher RD (1982) Comparison of acebutolol and propranolol for treatment of chronic ventricular arrhythmia: a placebo-controlled, double-blind, randomized crossover study. Circulation 65:1356–1364

    Article  PubMed  CAS  Google Scholar 

  45. DeSoyza N, Shapiro W, Chandraratna PAN, Aronow WS, Laddu AR, Thompson CH (1982) Acebutolol therapy for ventricular arrhythmias. A randomized, placebo-controlled double-blind multicenter study. Circulation 65:1129–1133

    Article  CAS  Google Scholar 

  46. Nademanee, K, Taylor, R, Bailey WE et al (2000) Treating electrical storm. Sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation 102:742

    Article  PubMed  CAS  Google Scholar 

  47. Morgera T, Pivotti F, Gori P, Maras P (1987) Mechanism of action and efficacy of verapamil and beta-blockers in exercise-induced ventricular tachycardia. Eur Heart J 8: D99–D105

    Article  Google Scholar 

  48. Vincent GM, Schwartz PJ, Denjoy I, Swan H, Bithell C, Spazzolini C, Crotti L, Piippo K, Lupoglazoff JM, Villain E, Priori SG, Napolitano C, Zhang L (2009) High efficacy of beta-blockers in long-QT syndrome type 1: contribution of noncompliance and QT-prolonging drugs to the occurrence of beta-blocker treatment “failures”. Circulation 119: 215–221

    Article  PubMed  CAS  Google Scholar 

  49. Hanyok JJ, Chow MS, Kluger J, Fieldman A (1988) Antifibrillatory effects of high dose bretylium and a lidocaine-bretylium combination during cardiopulmonary resuscitation. Crit Care Med 16:691–694

    Article  PubMed  CAS  Google Scholar 

  50. Naccarelli GV, Rinkenberger RL, Dougherty AH, Giebel RA (1985) Amiodarone: pharmacology and antiarrhythmic and adverse effects. Pharmacotherapy 5:298–313

    PubMed  CAS  Google Scholar 

  51. Hohnloser SH, Klingenhebe T, Singh BN (1994) Amiodarone-associated proarrhythmic effects: a review with special reference to Torsade de Pointes tachycardia. Ann Intern Med 121:529–535

    PubMed  CAS  Google Scholar 

  52. Desai AD, Chun S, Sung RJ (1997) The role of intravenous amiodarone in the management of cardiac arrhythmias. Ann Intern Med 127:294–303

    PubMed  CAS  Google Scholar 

  53. Naccarelli GV, Jalal S (1995) Intravenous amiodarone: Another option in the acute management of sustained ventricular tachyarrhythmias. Circulation 92:3154–3155

    Article  PubMed  CAS  Google Scholar 

  54. Herre JM, Sauve MJ, Malone P et al (1989) Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation. J Am Coll Cardiol 13:442–449

    Article  PubMed  CAS  Google Scholar 

  55. The CASCADE Investigators (1993) Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (the CASCADE study). Am J Cardiol 72:280–287

    Article  Google Scholar 

  56. The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators (1997) A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near fatal ventricular arrhythmias. N Engl J Med 337:1576–1583

    Article  Google Scholar 

  57. Connolly S, Gent M, Roberts R et al (1993) Canadian implantable defibrillator study (CIDS): study design and organization. Am J Cardiol 72:103F–108F

    Article  PubMed  CAS  Google Scholar 

  58. Moss AJ, Hall WJ, Cannom DS et al for the Multicenter Automatic Defibrillator Implantation Trial Investigators (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 335:1933–1940

    Article  PubMed  CAS  Google Scholar 

  59. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH for the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators (2005) Amiodarone or an implantable-cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237

    Article  PubMed  CAS  Google Scholar 

  60. Levine JH, Massumi A, Scheinman MM, Winkle RA, Platia EV, Chilson DA, Gomes A, Woosley RL (1996) Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias. Intravenous amiodarone multicenter trial group. J Am Coll Cardiol 27:67–75

    Article  PubMed  CAS  Google Scholar 

  61. Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A (2002) A randomized, blinded trial of intravenous amiodarone versus lidocaine in shock resistant ventricular fibrillation. N Engl J Med 346:884–890

    Article  PubMed  CAS  Google Scholar 

  62. Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE et al (1999) Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Eng J Med 341:871–878

    Article  CAS  Google Scholar 

  63. Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, Murphy E (2007) A Practical Guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm 4:1250–1259

    Article  PubMed  Google Scholar 

  64. Singh BN (1993) Electrophysiologic basis for the antiarrhythmic actions of sotalol and comparison with other agents. Am J Cardiol 72:8A–18A

    Article  PubMed  CAS  Google Scholar 

  65. Hanyok JJ (1993) Clinical pharmacokinetics of sotalol. Am J Cardiol 72:19A–26A

    Article  PubMed  CAS  Google Scholar 

  66. Julian DG, Jackson FS, Prescott RJ, Szekely P (1982) Controlled trial of sotalol for one year after myocardial infarction. Lancet 1:1142–1147

    Article  PubMed  CAS  Google Scholar 

  67. Naccarelli GV, Dougherty AH, Wolbrette D (1995) Antiarrhythmic drug-implantable cardioverter/defibrillator interactions. In: Zipes DP, Jalife J (eds) Cardiac electrophysiology: from cell to bedside. W.B. Saunders Co., Philadelphia, pp 1426–1433

    Google Scholar 

  68. Stevens SK, Haffajee CI, Naccarelli GV, Schwartz KM, Luceri RM, Packer DL, Kowey PR, Rubin AM, and the Propafenone DFT Investigators (1996) The effects on defibrillation and pacing thresholds of oral propafenone in patients receiving permanent pacer-cardioverter-defibrillator devices. J Am Coll Cardiol 28:418–422

    Article  PubMed  CAS  Google Scholar 

  69. Connolly SJ, Dorian P, Roberts RS, Gent M, Bailin S, Fain ES, Thorpe K, Champagne J, Talajic M, Coutu B, Gronefeld GC, Hohnloser SH, Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) Investigators (2006) Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC Study: a randomized trial. JAMA 295(2):165–171

    Article  PubMed  CAS  Google Scholar 

  70. Stevenson WG, Soejima K (2007) Catheter ablation for ventricular tachycardia. Circulation 115:2750–2760

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Naccarelli, G.V., Field, J. (2011). Ventricular Tachycardia and Fibrillation: Pharmacologic Therapy. In: Yan, GX., Kowey, P. (eds) Management of Cardiac Arrhythmias. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-161-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-161-5_11

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-160-8

  • Online ISBN: 978-1-60761-161-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics