Reassessment of benefit-risk ratio and treatment algorithms for antiarrhythmic drug therapy after the cardiac arrhythmia suppression trial

Journal of Clinical Pharmacology
J L Anderson

Abstract

The Cardiac Arrhythmia Suppression Trial (CAST) has led to serious reconsideration of both the benefit-risk ratio of antiarrhythmic drug therapy and the appropriate therapeutic approach to various cardiac arrhythmias. Class IC drugs, such as encainide and flecainide, should not be used to treat asymptomatic postinfarction arrhythmias. Furthermore, because the CAST raises serious questions about the concept of treating asymptomatic but "potentially malignant" (prognostically important) arrhythmias guided by ambulatory monitoring, the prophylactic use of any of the antiarrhythmic agents (except beta blockers) must be considered inappropriate and potentially harmful until otherwise established by specific clinical trials. For prophylaxis of malignant ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation), treatment may still begin with standard agents in classes IA, IB, or both, preferably guided by electrophysiologic testing alone or in combination with noninvasive testing. Class IC therapy may be most useful in those patients in this group who do not have such high-risk characteristics for proarrhythmia as a history of multiple myocardial infarctions (MIs), congestive heart failure, or low ejecti...Continue Reading

References

Jan 16, 1990·The American Journal of Cardiology·C M Pratt, L A Moye
Aug 29, 1986·The American Journal of Cardiology·J W Mason
Aug 1, 1987·The American Journal of Cardiology·J L AndersonJ Friedman
Aug 10, 1989·The New England Journal of Medicine·UNKNOWN Cardiac Arrhythmia Suppression Trial (CAST) Investigators
Mar 1, 1985·Progress in Cardiovascular Diseases·S YusufP Sleight
Mar 1, 1988·The American Journal of Cardiology·UNKNOWN Cardiac Arrhythmia Pilot Study (CAPS) Investigators
Aug 25, 1988·The American Journal of Cardiology·J L AndersonP A Fredell
May 1, 1988·The American Journal of Cardiology·M D MeissnerS P Kutalek
Mar 1, 1988·Postgraduate Medicine·J L Anderson
Sep 1, 1988·The American Journal of Cardiology·J Morganroth, L N Horowitz
Sep 1, 1986·Journal of the American College of Cardiology·J MorganrothG D Gentzkow
Dec 20, 1980·Lancet·D A ChamberlainR G Shanks
Jan 1, 1983·The American Journal of Cardiology·D A RichardsJ B Uther
Apr 1, 1983·The American Journal of Cardiology·J L AndersonL S Green
Apr 1, 1984·Journal of Clinical Pharmacology·E M Vaughan Williams
Sep 22, 1983·The American Journal of Cardiology·J T Bigger
Sep 1, 1983·Journal of Cardiovascular Pharmacology·E Patterson, B R Lucchesi
Feb 1, 1984·The American Journal of Cardiology·J L AndersonJ M Nappi
Sep 22, 1983·The American Journal of Cardiology·C D Furberg
Aug 3, 1984·JAMA : the Journal of the American Medical Association·J Morganroth

❮ Previous
Next ❯

Citations

Mar 1, 1994·Clinical Cardiology·J A ReiffelR DiBianco
Feb 1, 1992·Cardiovascular Drugs and Therapy·J Morganroth
Jul 1, 1996·Journal of Cardiovascular Electrophysiology·M S LinkN A Estes
Sep 5, 2012·Expert Review of Clinical Pharmacology·Daniel S Sitar
Nov 14, 1997·The American Journal of Cardiology·D J MacNeil
Nov 1, 1991·Circulation·D M Salerno
Jan 1, 1996·Journal of Cardiovascular Pharmacology and Therapeutics·J A Reiffel

❮ Previous
Next ❯

Related Concepts

Related Feeds

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Anti-Arrhythmic Drug Therapies

Anti-arrhythmic drugs are used to prevent abnormal heart rhythms. These medications are used in conditions including, ventricular tachycardia, ventricular fibrillation and atrial fibrillation. Discover the latest research on anti-arrhythmic drug therapies here.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Antiarrhythmic Agents: Mechanisms of Action

Understanding the mechanism of action of antiarrhythmic agents is essential in developing new medications as treatment of cardiac arrhythmias is currently limited by the reduced availability of safe and effective drugs. Discover the latest research on Antiarrhythmic Agents: Mechanism of Action here.