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Efficacy and Limitations of Quinidine in Patients With Brugada Syndrome
- Source :
- Circulation: Arrhythmia and Electrophysiology. 12
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
Abstract
- Background:Quinidine at high dose is suggested as antiarrhythmic treatment in patients with Brugada Syndrome (BrS), but its efficacy to prevent life-threatening arrhythmic events (LAE) in this population is unproven and its use limited by frequent side effects. We assessed whether low-dose quinidine in patients with BrS reduces the following: (1) the occurrence of LAEs at follow-up, as compared to no therapy, in a population of both high-risk survivors of LAE and lower risk patients asymptomatic for LAEs and (2) the arrhythmic burden in the high-risk group of cardiac arrest survivors.Methods:We compared the clinical course of 53 patients with BrS treated with quinidine to that of 441 untreated controls, matched by sex, age, symptoms, and the duration of observation. Furthermore, we calculated the annual incidence of LAE off-quinidine and on-quinidine in 123 patients with BrS who were cardiac arrest survivors.Results:Fifty-three patients with BrS (89% males, median age 39.8 years) received quinidine (439±115 mg/d) for 5.0±3.7 years. Therapy was stopped in 3 cases (6%) for side effects. Quinidine reduced by 26% the risk of experiencing an LAE in cases versus controls (hazard ratio, 0.74; 95% CI, 0.22–2.48;P=0.62). Furthermore, in 27 of 123 patients with BrS symptomatic for LAEs who were treated for 7.0±3.5 years, the annual rate of LAEs decreased from 14.7% while off-quinidine to 3.9% while on-quinidine (P=0.03). Of note, recurrent LAEs were recorded in 4 (15%) cardiac arrest survivors while on-quinidine.Conclusions:We demonstrated for the first time in the long-term that low-dose quinidine reduces recurrent LAEs in patients with BrS who had already survived an LAE, with few side effects. Remarkably, 15% of patients symptomatic for LAEs experience recurrent life-threatening arrhythmias while on-treatment, suggesting that quinidine cannot replace implantable defibrillators in high-risk subjects.
- Subjects :
- Quinidine
medicine.medical_specialty
business.industry
030204 cardiovascular system & hematology
medicine.disease
sudden cardiac death
Sudden cardiac death
cardiac arrhythmia
03 medical and health sciences
Antiarrhythmic drug
0302 clinical medicine
Physiology (medical)
Internal medicine
Cardiology
Medicine
Brugada syndrome
In patient
030212 general & internal medicine
Cardiology and Cardiovascular Medicine
business
quinidine
medicine.drug
Subjects
Details
- ISSN :
- 19413084 and 19413149
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- Circulation: Arrhythmia and Electrophysiology
- Accession number :
- edsair.doi.dedup.....bbed3be9ba848bb035fa09cf59cc90c0