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Quinidine-Responsive Polymorphic Ventricular Tachycardia in Patients With Coronary Heart Disease.

Authors
  • Viskin, Sami1
  • Chorin, Ehud1
  • Viskin, Dana1
  • Hochstadt, Aviram1
  • Halkin, Amir1
  • Tovia-Brodie, Oholi1
  • Lee, John K2
  • Asher, Elad3
  • Laish-Farkash, Avishag3
  • Amit, Guy4
  • Havakuk, Ofer1
  • Belhassen, Bernard1
  • Rosso, Raphael1
  • 1 Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., E.C., D.V., A. Hochstadt, A. Halkin, O.T-B., O.H., B.B., R.R.). , (Israel)
  • 2 St Luke's Hospital Mid America Heart Institute, Kansas City, MO (J.K.L.).
  • 3 Assuta Ashdod University Hospital, Ashdod, Israel (E.A., A.L.-F.). , (Israel)
  • 4 Soroka Medical Center and Beer-Sheva University of the Negev, Israel (G.A.). , (Israel)
Type
Published Article
Journal
Circulation
Publisher
Ovid Technologies Wolters Kluwer -American Heart Association
Publication Date
May 14, 2019
Volume
139
Issue
20
Pages
2304–2314
Identifiers
DOI: 10.1161/CIRCULATIONAHA.118.038036
PMID: 30696267
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Polymorphic ventricular tachycardia (VT) without QT prolongation is well described in patients without structural heart disease (mainly idiopathic ventricular fibrillation and Brugada syndrome) and in patients with acute ST-elevation myocardial infarction. Retrospective study of patients with polymorphic VT related to coronary artery disease, but without evidence of acute myocardial ischemia. The authors identified 43 patients in whom polymorphic VT developed within days of an otherwise uncomplicated myocardial infarction or coronary revascularization procedure. The polymorphic VT events were invariably triggered by extrasystoles with short (364±36 ms) coupling interval. Arrhythmic storms (4-16 events of polymorphic VT deteriorating to ventricular fibrillation) occurred in 23 (53%) patients. These arrhythmic storms were always refractory to conventional antiarrhythmic therapy, including intravenous amiodarone, but invariably responded to quinidine therapy. In-hospital mortality was 17% for patients with arrhythmic storm. Patients treated with quinidine invariably survived to hospital discharge. During long-term follow-up (of 5.6±6 years; range, 1 month to 18 years), 3 (16%) of patients discharged without quinidine developed recurrent polymorphic VT. There were no recurrent arrhythmias during quinidine therapy Conclusions: Arrhythmic storm with recurrent polymorphic VT in patients with coronary disease responds to quinidine therapy when other antiarrhythmic drugs (including intravenous amiodarone) fail.

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