Long Term Efficacy of Antiarrhythmic Drugs in ARVCD

Adequate monitoring of drug efficacy is a prerequisite for long-term antiarrhythmic drug therapy in ARVC/D. Empiric antiarrhythmic drug treatment without evidence for appropriate suppression of the clinical arrhythmia cannot be recommended due to a high incidence of VT recurrences and a significant mortality from sudden death during long-term follow-up [18-21].

Assessment of antiarrhythmic drug efficacy by serial electrophysiologic studies (inducible VT) or Holter monitoring combined with exercise testing and/or provocation with intravenous cate-cholamines (noninducible VT) provided better long-term outcomes when compared with empiric drug treatment. VT recurrence rates were low in patients who were discharged on a drug that was tested to be effective, whereas sudden deaths and VT relapses predominantly occurred in patients with insufficient VT suppression at discharge, those with significant progression of ARVC/D, or those with inappropriate dosage (noncompliance) of the tested antiarrhythmic drug [25] (Fig. 18.4). In this context, it is important to stress the need for long-term follow-up of patients with visits at regular intervals, not only to detect a progressive course of

Freedom of VT recurrence pis. with Inappropriate anjgdcsaflK n= 143 pis

Freedom of VT recurrence pis. with Inappropriate anjgdcsaflK n= 143 pis

Fig.18.4 • Long-term outcome of 143 patients with ARVC/D and low risk of sudden death discharged on antiarrhythmic drugs after serial drug testing (follow-up: 53±32 months). The incidence of sudden death was low,the recurrence rate of ventricular tachycardia (VT) was acceptable (25% after 5 years). In the subgroup of patients who were noncompli-ant or with unsuccessful serial drug testing, the VT recurrence rate approached 60% after 3 years.Adapted from [25] with permission from Urban & Vogel GmbH

ARVC/D but also to improve and optimize patient compliance.

A 12-lead surface ECG on antiarrhythmic drug treatment should be performed at regular intervals with particular attention to QRS width (class-1 drugs) and QT-interval (class-3 and class-1a drugs). In addition, electrolyte disturbances (especially hy-pokalemia) should be avoided and attention should be given to potential drug interactions (particularly those with QT-prolongation) in order to prevent proarrhythmic drug effects.

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