Quinidine-Responsive Polymorphic Ventricular Tachycardia in Patients with Coronary Heart Disease

Sami Viskin, Ehud Chorin, Dana Viskin, Aviram Hochstadt, Amir Halkin, Oholi Tovia-Brodie, John K. Lee, Elad Asher, Avishag Laish-Farkash, Guy Amit, Ofer Havakuk, Bernard Belhassen, Raphael Rosso

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Background: Polymorphic ventricular tachycardia (VT) without QT prolongation is well described in patients without structural heart disease (mainly idiopathic ventricular fibrillation and Brugada syndrome) and in patients with acute ST-elevation myocardial infarction. Methods: Retrospective study of patients with polymorphic VT related to coronary artery disease, but without evidence of acute myocardial ischemia. Results: The authors identified 43 patients in whom polymorphic VT developed within days of an otherwise uncomplicated myocardial infarction or coronary revascularization procedure. The polymorphic VT events were invariably triggered by extrasystoles with short (364±36 ms) coupling interval. Arrhythmic storms (4-16 events of polymorphic VT deteriorating to ventricular fibrillation) occurred in 23 (53%) patients. These arrhythmic storms were always refractory to conventional antiarrhythmic therapy, including intravenous amiodarone, but invariably responded to quinidine therapy. In-hospital mortality was 17% for patients with arrhythmic storm. Patients treated with quinidine invariably survived to hospital discharge. During long-term follow-up (of 5.6±6 years; range, 1 month to 18 years), 3 (16%) of patients discharged without quinidine developed recurrent polymorphic VT. There were no recurrent arrhythmias during quinidine therapy Conclusions: Arrhythmic storm with recurrent polymorphic VT in patients with coronary disease responds to quinidine therapy when other antiarrhythmic drugs (including intravenous amiodarone) fail.

Original languageEnglish
Pages (from-to)2304-2314
Number of pages11
JournalCirculation
Volume139
Issue number20
DOIs
StatePublished - 14 May 2019
Externally publishedYes

Keywords

  • myocardial infarction
  • myocardial ischemia
  • quinidine
  • tachycardia, ventricular
  • torsade de pointes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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