Identification of potentially effective antiarrhythmic drugs to individualize premature ventricular contraction therapy in patients without structural cardiac changes

Abstract

Aim. To individualize premature ventricular contraction (PVC) therapy in patients without structural cardiac changes by identifying potentially effective antiarrhythmic agents.Material and methods. The study included 122 patients aged 20 to 43 years without structural cardiac changes with class IV-V PVC (Rayn B. classification (1984)) and subjective arrhythmia signs. After 24-hour Holter monitoring, the selection of potentially effective antiarrhythmic agents for terminating PVC was carried out on the basis of an increase in premature beat index after the third dose compared with the initial data of >2 relative units. The accuracy of drug choice was evaluated according to 24-hour ECG monitoring after a short course of therapy for each tested antiarrhythmic agent for at least 5 days. The follow-up duration ranged from 1 to 4-5 years. The endpoint was the duration of positive antiarrhythmic effect of the drugs used.Results. In 55,74% of patients, a positive antiarrhythmic effect was detected in two agents, in 34,43% — in three, and in the rest — in four antiarrhythmic drugs. The accuracy of drug choice averaged over 90%. In 18,85% of patients, the antiarrhythmic effect of PVC therapy maintained for less than 1 year (on average 0,8±0,05 years), in other patients, from 1 year to 5 years (on average 3,7±0,09 years) (p<0,05). The duration of maintaining a positive clinical effect for 1 year or more correlated with true positive results (r=0,94), and less than 1 year — with false negative results of testing with antiarrhythmic drugs (r=0,92).Conclusion. In all patients without structural cardiac changes with PVC, a potential positive antiarrhythmic effect was detected for two or more drugs. The accuracy of choosing potentially effective drugs for terminating PVC in these patients averaged over 90%.

Keywords

• premature ventricular contraction
• differentiated therapy. relationships and activities: none