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European Heart Journal 1985 6(4):312-322;
Copyright © 1985 by the European Society of Cardiology.
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© 1985 The European Society of Cardiology

Intraindividual comparison of intravenous ajmaline and quinidine in patients with sustained ventricular tachycardia: Effects on normal myocardium and on arrhythmia characteristics

W. LENGFELDER, J. SENGES, I. RIZOS, R. JAUERNIG, J. BRACHMANN, K. von OHLSHAUSEN and W. KÜBLER

Abteilung Innere Medizin III (Kardiologie), Medizinische Universitätsklinik Heidelberg, F.R.G.

Received 7 August 1984; revised 10 January 1985; .

Jochen Senges, Medizinische Klinik B der Städt. Krankenanstalten, Bremsertr. 79, 6700 Lundwigshafen, F.R.G.

Abstract

Intraindividual comparison of the acute response to intravenous quinidine and to intravenous ajmaline was performed in 23 patients with sustained ventricular tachycardia (VT) who underwent serial electrophysiological studies. In each patient, sustained VT could be reproducibly initiated by programmed ventricular stimulation during control studies. Inducibility of sustained VT was prevented after quinidine in 6 of the 23 patients (26%) and after ajmaline in 8 of the same 23 cases (35%). Agreement between the effects of both drugs was not significant: 2 patients had a similar response to both quinidine and ajmaline and 11 patients did not have a response to either of the two drugs, resulting in a total of only 13 patients (57%) who had a similar response to both drugs.In the 11 non-responders with inducible sustained VT before and after both drugs, quinidine and ajmaline caused qualitatively and quantitatively similar alterations of VT characteristics including a significant prolongation of the interval between the initiation extrastimulus and the first beat of VT by 38 and 42% (P<0.01), an increase in VT cycle length by 15 and 22% (P<0.01) and a prolongation of the QRS duration during VT by 15 and 18% (P<0.01), respectively. In all 23 patients, quinidine and ajmaline caused a quantitatively similar prolongation of ventricular refractoriness by 11 and 9% (P<0.05), of the QRS duration at sinus rhythm by 10 and 15% (P<0.01) and of the QTc interval by 13 and 10% (P<0.05), respectively. Thus, ajmaline and quinidine appear to have similar electrophysiological effects on both normal myocardiumand on indirect parameters of reentry; in individual patients with sustained VT, however, such electrophysiological similarities do not result in significant agreement of preventive responses.

Key Words: Antiarrhythmic drugs • ventricular tachycardia • electrophysiological studies • programmed stimulation • sudden death


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