The role of quinidine in the pharmacological therapy of ventricular arrhythmias‘Quinidine’
2018
Background: Historically, quinidine was the first medicine used in the
therapy of heart arrhythmias. Studies in the early 20th century identified
quinidine, a diastereomer of the antimalarial quinine, as the most potent of
the antiarrhythmic substances extracted from the cinchona plant. Quinidine
is used by the 1920s, as an antiarrhythmic agent to maintain sinus rhythm
after conversion from atrial flutter or atrial fibrillation and to prevent
recurrence of ventricular tachycardia or ventricular fibrillation. Its value
in chronic prophylaxis of relapse of ventricular arrhythmia was brought
under suspicion after publishing of meta analysis that showed that the
application of quinidine increases mortality. Due to numerous proofs of
increased risk for the appearance of ventricular arrhythmia and sudden
death, as well as a number of other adverse effects and drug interactions,
quinidine was withdrawn from use and in the recent years has become
unavailable in many countries. On the other hand, recent studies have
demonstrated that quinidine is the only oral medication that has
consistently shown efficacy in preventing arrhythmias and terminating storms
due to recurrent ventricular fibrillation, in patients with Brugada
syndrome, idiopathic ventricular fibrillation and early repolarization
syndrome. Quinidine is also the only antiarrhythmic drug that normalized the
QT interval in patients with the congenital short QT syndrome.
Objective: The aim of this review is to provide good insight into pro and
contra arguments for quinidine use in ventricular arrhythmias evidence based
on recently published literature.
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