Deshmukh Amrish, Larson John, Ghannam Michael, Saeed Mohammed, Cunnane Ryan, Ghanbari Hamid, Latchamsetty Rakesh, Crawford Thomas, Jongnarangsin Krit, Pelosi Frank, Chugh Aman, Oral Hakan, Morady Fred, Bogun Frank, Liang Jackson J
Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2021 Dec;32(12):3173-3178. doi: 10.1111/jce.15260. Epub 2021 Oct 6.
Quinidine is an effective therapy for a subset of polymorphic ventricular tachycardia and ventricular fibrillation (VF) syndromes; however, the efficacy of quinidine in scar-related monomorphic ventricular tachycardia (MMVT) is unclear.
Between 2009 and 2020 a single VT referral center, a total of 23 patients with MMVT and structural heart disease (age 66.7 ± 10.9, 20 males, 15 with ischemic cardiomyopathy, mean LVEF 22.2 ± 12.3%, 9 with left ventricular assist device [LVAD]) were treated with quinidine (14 quinidine gluconate; 996 ± 321 mg, 8 quinidine sulfate; 1062 ± 588 mg). Quinidine was used in combination with other antiarrhythmics (AAD) in 19 (13 also on amiodarone). All patients previously failed >1 AAD (amiodarone 100%, mexiletine 73%, sotalol 32%, other 32%) and eight had prior ablations (median of 1.5). Quinidine was initiated in the setting of VT storm despite AADs (6), inability to tolerate other AADs (4), or recurrent VT(12). Ventricular arrhythmias recurred despite quinidine in 13 (59%) patients at a median of 26 (4-240) days after quinidine initiation. In patients with recurrent MMVT, VT cycle length increased from 359 to 434 ms (p = .02). Six (27.3%) patients remained on quinidine at 1 year with recurrence of ventricular arrhythmias in all. The following adverse effects were seen: gastrointestinal side effects (6), QT prolongation (2), rash (1), thrombocytopenia (1), neurologic side effects (1). One patient discontinued due to cost.
Quinidine therapy has limited tolerability and long-term efficacy when used in the management of amiodarone-refractory scar-related MMVT.
奎尼丁是治疗一部分多形性室性心动过速和室颤（VF）综合征的有效疗法；然而，奎尼丁在瘢痕相关单形性室性心动过速（MMVT）中的疗效尚不清楚。
2009年至2020年期间，在一个单一的室性心动过速转诊中心，共有23例患有MMVT和结构性心脏病的患者（年龄66.7±10.9岁，男性20例，15例患有缺血性心肌病，平均左心室射血分数[LVEF]为22.2±12.3%，9例使用左心室辅助装置[LVAD]）接受了奎尼丁治疗（14例使用葡萄糖酸奎尼丁；996±321mg，8例使用硫酸奎尼丁；1062±588mg）。19例患者（其中13例同时使用胺碘酮）将奎尼丁与其他抗心律失常药物（AAD）联合使用。所有患者之前均有>1种AAD治疗失败（胺碘酮100%，美西律73%，索他洛尔32%，其他32%），8例患者曾接受过消融治疗（中位数为1.5次）。尽管使用了AAD，但在室性心动过速风暴期间（6例）、无法耐受其他AAD（4例）或室性心动过速复发（12例）的情况下开始使用奎尼丁。在开始使用奎尼丁后，13例（59%）患者在中位数为26（4 - 240）天的时间内出现室性心律失常复发。在复发性MMVT患者中，室性心动过速周期长度从359毫秒增加到434毫秒（p = 0.02）。1年后，6例（27.3%）患者仍在使用奎尼丁，所有患者均出现室性心律失常复发。观察到以下不良反应：胃肠道副作用（6例）、QT间期延长（2例）、皮疹（1例）、血小板减少（1例）、神经系统副作用（1例）。1例患者因费用问题停药。
当奎尼丁用于治疗胺碘酮难治性瘢痕相关MMVT时，其耐受性和长期疗效有限。
