Metabolites of antiarrhythmic drugs: are they clinically important?
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VT may be observed to accompany a wide variety of heart diseases and occasionally no heart disease at all. The efficacy of drug therapy is dependent on antiarrhythmic effects and the mechanism underlying the patient's VT. Conventional antiarrhythmic agents appear to be effective in no more than one third of patients, but a substantial number of other potentially useful antiarrhythmic agents exist. Unfortunately, their effectiveness in treating sustained VT for the most part must still be proved. Other agents such as amiodarone appear effective, but ways to predict which patients will benefit remain unknown. Invasive and noninvasive techniques exist for assessing therapeutic efficacy, but determination of which is more appropriate awaits a wider experience and more direct comparison.
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The authors provide an overview of the general features of pharmacokinetics and report the pharmacodynamic and pharmacokinetic interactions of selected antiarrhythmic drugs. Their clinical experience in the use of investigational antiarrhythmic drugs is also presented.
Currently available antiarrhythmic drugs possess very poor therapeutic-to-toxic ratios, and therefore, there is a great deal of interest in the development of new investigational agents to suppress ventricular rhythm disturbances. This article includes most of the investigational ventricular antiarrhythmic drugs in which there has been a great deal of recent active investigation and interest. It stresses the different patient populations that have been tested with each of these antiarrhythmic drugs, pointing out those drugs that have been documented to be effective in nonsustained ventricular tachycardia or sustained ventricular tachycardia and sudden cardiac death.
This article has attempted to review selected clinical features of new antiarrhythmic agents for treatment of recurrent ventricular tachycardia and ventricular fibrillation. While it is apparent that the ideal antiarrhythmic agent does not exist, whether it be a new or old antiarrhythmic drug, effective and safe antiarrhythmic drug therapy can nevertheless be administered to many patients if the pharmacologic principles and properties described herein are carefully considered.
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