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... ,“Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death: Observations From the ...
SG Ayalloore... - Circulation, 2011 - Am Heart Assoc The strategy of suppressing ventricular ectopy by pharmaceutical means in the peri-infarct period has been fraught with disappointment and has tinted our view of the approach, as can be seen in the accompanying editorial by Patton. 1 The Cardiac Arrhythmia ...
Letter by Ayalloore and Le Lorier Regarding Article, “Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death: Observations From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial”
The strategy of suppressing ventricular ectopy by pharmaceutical means in the peri-infarct period has been fraught with disappointment and has tinted our view of the approach, as can be seen in the accompanying editorial by Patton.1 The Cardiac Arrhythmia Suppression Trial showed that premature ventricular beat suppression did not prevent sudden cardiac death, but rather increased the risk secondary to the proarrhythmic effects of the antiarrhythmic drugs used.2 Several other trials have reaffirmed these results. In the European Myocardial Infarct Amiodarone Trial, amiodarone failed to show a mortality benefit. However, in this trial, the decrease in deaths from arrhythmias was balanced by the increase in noncardiac deaths.3 We would argue, in light of the work by Morrow et al on the Effects of Ranolazine on Recurrent Cardiovascular Events in Patients With Non-ST-elevation Acute Coronary Syndromes, MERLIN-TIMI-36, that perhaps it is time to revisit the strategy.
Ranolazine is an antianginal agent that inhibits the late sodium channel, and therefore possesses antiarrhythmic properties. In Dr Morrow's study, ranolazine was able to significantly prevent ventricular tachycardia seen on a Holter monitor,4 and no increase or decrease in mortality for ranolazine as adjunctive therapy in non-ST-segment elevation myocardial infarction could be demonstrated, a first among antiarrhythmics. In a clever study, Lemmert et al took 1473 Holter readings from 3 separate ST-segment elevation myocardial infarction trials in which the patients received Holter monitors prior to revascularization. They described an innovative measurement, the R-R interval irregularity, by analyzing all ...
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... ,“Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death: Observations From the ... |
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