Document Detail


Antiarrhythmic therapy and survival following myocardial infarction.
MedLine Citation:
PMID:  1725053     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Arrhythmias remain a major cause of late mortality following myocardial infarction. They arise due to fibrosis within the infarct, which creates the conditions of slow conduction necessary for re-entry. In individual patients who have already manifested a malignant arrhythmia, antiarrhythmic drug therapy, guided by invasive electrophysiological testing, is of proven benefit in prolonging survival. By contrast, when used on a population basis, antiarrhythmic drug therapy has proved singularly ineffective. This is illustrated by the recent Cardiac Arrhythmia Suppression Trial (CAST) study--far from improving survival, antiarrhythmic therapy increased mortality. The use of antiarrhythmic drugs on a population basis is therefore fundamentally flawed. Hemodynamic intervention provides an alternative strategy in arrhythmia prevention. Hemodynamic changes may influence electrophysiological parameters and arrhythmogenesis in a number of ways. First, myocardial stretch may contribute to arrhythmogenesis through contraction-excitation feedback. Second, hemodynamic changes can influence ventricular remodeling following infarction, which may be an important determinant of subsequent arrhythmogenesis. Hemodynamic intervention, therefore, represents a promising new approach to arrhythmia prevention following myocardial infarction.
Authors:
J C Cowan; D S Coulshed; A G Zaman
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of cardiovascular pharmacology     Volume:  18 Suppl 2     ISSN:  0160-2446     ISO Abbreviation:  J. Cardiovasc. Pharmacol.     Publication Date:  1991  
Date Detail:
Created Date:  1992-04-28     Completed Date:  1992-04-28     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7902492     Medline TA:  J Cardiovasc Pharmacol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S92-8     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Studies, University of Leeds, England.
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MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / therapeutic use*
Humans
Myocardial Infarction / drug therapy*,  mortality
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

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