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

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%.

1. Кэмм АДж, Люшер ТФ, Серруис ПВ. Болезни сердца и сосудов. Руководство Европейского общества кардиологов (перевод с англ.). М.: ГЭОТАР-Медиа, 2011. 1480 с. ISBN: 978-5-9704-1872-7.

2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018;72(14):1677-749. doi:10.1016/j.jacc.2017.10.053.

3. Olesin AI, Koziy AV, Semenova EV, et al. Clinical assessment of life-threatening ventricular arrhythmia predictor in patients with ventricular exstrasystolia and no morphological heart pathology (a prospective study). Russian Journal of Cardiology. 2010;(1):5-12. (In Russ.) doi:10.15829/1560-4071-2010-1-5-12.

4. Olesin AI, Konovalova OA, Koziy AV, et al. Ventricular extrasystolia in patients with non-ST elevation acute coronary syndrome: assessing the risk of life-threatening ventricular 9. arrhythmias (clinico-experimental study). Russian Journal of Cardiology. 2009;1:24-31. (In Russ.) doi:10.15829/1560-4071-2009-1-24-30.

5. Olesin AI, Konstantinova IV, Litvinenko VA, Zueva JS. The method of choosing the effective antiarrhythmic drug for patients with extrasystole. Patent RU № 2707261, publ. 25.11.2019, Bul. 33. 33 р. (In Russ.) http://www.findpatent.ru/patent/270/2707261.html.

6. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39. doi:10.1016/j.echo.2014.10.003.

7. Udelson JE, Dilsizian V, Bonow RO. Appropriate Use Criteria. Multimodality Imaging in Stable Ischemic Heart Disease and Heart Failure. In: Braunwald's Heart Disease. A textbook of cardiovascular medicine. 11th ed. Zipes DP, Libby P, Bonow RO, et al. Elsevier Science. 2018:343-7. ISBN: 978-0-323-55593-7.

8. Panizo JG, Barra S, Mellor G, et al. Premature Ventricular Complex-induced Cardiomyopathy. Arrhythm. Electrophysiol. Rev. 2018;7(2):128-34. doi:10.15420/aer.2018.23.2.

9. Antzelevitch C, Burashnikov A. Overview of Basic Mechanisms of Cardiac Arrhythmia. Card. Electrophysiol. Clin. 2011;3(1):23-45. doi:10.1016/j.ccep.2010.10.012.

10. Wang Y, Eltit JM, Kaszala K, et al. Cellular mechanism of premature ventricular contraction-induced cardiomyopathy. Heart Rhytm. 2014;11(11):2064-72. doi:10.1016/j.hrthm.2014.07.022.

11. Sovari AA. Cellular and molecular mechanisms of arrhythmia by oxidative stress. Cardiol. Res. Pract. 2016;2016: 9656078. doi:101155/2016/9656078.