Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Lipscomb University College of Pharmacy, Nashville, Tennessee, USA.
JACC Clin Electrophysiol. 2021 Oct;7(10):1254-1263. doi: 10.1016/j.jacep.2021.03.024. Epub 2021 Jun 30.
This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD) options.
Therapeutic options are often limited in patients with structural heart disease and recurrent VAs. Quinidine has an established role in rare arrhythmic syndromes, but its potential use in other difficult VAs has not been assessed in the present era.
We performed a retrospective analysis of 37 patients who had in-hospital quinidine initiation after multiple other therapies failed for VA suppression at our tertiary referral center. Clinical data and outcomes were obtained from the medical record.
Of 30 patients with in-hospital quantifiable VA episodes, quinidine reduced acute VA from a median of 3 episodes (interquartile range [IQR]: 2 to 7.5) to 0 (IQR: 0 to 0.5) during medians of 3 days before and 4 days after quinidine initiation (p < 0.001). VA events decreased from a median of 10.5 episodes per day (IQR: 5 to 15) to 0.5 episodes (IQR: 0 to 4) after quinidine initiation in the 12 patients presenting with electrical storm (p = 0.004). Among the 24 patients discharged on quinidine, 13 (54.2%) had VA recurrence during a median of 138 days. Adverse effects in 9 of the 37 patients (24.3%) led to drug discontinuation, most commonly gastrointestinal intolerance.
In patients with recurrent VAs and structural heart disease who have limited treatment options, quinidine can be useful, particularly as a short-term therapy.
本研究旨在回顾奎尼丁在反复持续性室性心律失常（VA）且抗心律失常药物（AAD）选择有限的患者中的应用。
结构性心脏病和反复 VA 患者的治疗选择往往有限。奎尼丁在罕见心律失常综合征中具有既定作用，但在当前时代，尚未评估其在其他难治性 VA 中的潜在应用。
我们对在我们的三级转诊中心，因 VA 抑制而多次治疗失败后开始使用院内奎尼丁的 37 例患者进行了回顾性分析。从病历中获取临床数据和结局。
在 30 例有可量化的院内 VA 发作的患者中，奎尼丁将急性 VA 从中位数 3 次（四分位距 [IQR]：2 至 7.5）降低至奎尼丁开始前中位数 3 天和开始后中位数 4 天的 0 次（IQR：0 至 0.5）（p < 0.001）。在 12 例电风暴患者中，VA 发作从中位数 10.5 次/天（IQR：5 至 15）减少至奎尼丁开始后的 0.5 次/天（IQR：0 至 4）（p = 0.004）。在 24 例出院带奎尼丁的患者中，13 例（54.2%）在中位数 138 天内出现 VA 复发。37 例患者中有 9 例（24.3%）出现不良反应导致药物停用，最常见的是胃肠道不耐受。
在反复 VA 和结构性心脏病且治疗选择有限的患者中，奎尼丁可能是有用的，特别是作为短期治疗。
