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      Should Ventricular Premature Depolarizations Be Treated? If So, How?

      Cardiology

      S. Karger AG

      Ventricular premature depolarizations, Sudden cardiac death, Antiarrhythmic drugs, Ischemic heart disease

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          Abstract

          Complex ventricular premature depolarizations (VPDs) in the presence of ischemic heart disease, especially in the presence of left ventricular dysfunction, are associated with an increased incidence of sudden cardiac death. However, we have no hard data from prospective, randomized, double-blind studies demonstrating that abolition or reduction of VPDs will reduce mortality. Moreover, the drugs available to treat VPDs may not abolish or reduce VPDs in the individual patient, occasionally may exacerbate ventricular arrhythmias, and may produce toxic effects. Spontaneous variability of VPDs may also mimic an antiarrhythmic drug effect. Clinical judgment must be used to determine which patients with VPDs should be treated, with which antiarrhythmic drug or combination of drugs, given in what doses, to which blood levels or therapeutic endpoints. We need to determine in the individual patient which methods of monitoring the efficacy and toxicity of antiarrhythmic drugs should be used and how often. I treat patients with known heart disease with chronic oral antiarrhythmic drugs if they have frequent VPDs (more than five per minute), multifocal VPDs, couplets or short runs of ventricular tachycardia, or the R on T phenomenon. Patients with complex VPDs should especially be treated with antiarrhythmic drugs if they have survived a cardiac arrest, if they have poor left ventricular function, if they have sustained an acute myocardial infarction within 1 year, if they have unstable angina pectoris, if they have severe stable angina pectoris, if they have exhibited complex VPDs during treadmill stress testing associated with a low heart rate, an inappropriate blood pressure response to exercise, S-T segment depression at least 2.0 mm, or a short exercise duration, if they have a prolonged Q-Tc interval, and if they are symptomatic. I do not treat VPDs in asymptomatic patients who have no evidence of heart disease.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-3588-5
          978-3-318-01756-4
          0008-6312
          1421-9751
          1982
          1982
          07 November 2008
          : 69
          : Suppl 1
          : 225-234
          Affiliations
          Cardiovascular Division, University of California, Irvine, Calif, USA
          Article
          173558 Cardiology 1982;69:225–234
          10.1159/000173558
          © 1982 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 10
          Categories
          Final Session

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