Challenge and Impact of Quinidine Access in Sudden Death Syndromes: A National Experience.

Adolescent Adult Aged Aged, 80 and over Anti-Arrhythmia Agents / therapeutic use Brugada Syndrome / complications Child Death, Sudden, Cardiac / etiology Female Humans Male Middle Aged Practice Guidelines as Topic Quinidine / therapeutic use Retrospective Studies Young Adult

implantable cardioverter-defibrillator shocks quinidine sudden cardiac death ventricular arrhythmia

Journal

JACC. Clinical electrophysiology

ISSN: 2405-5018

Titre abrégé: JACC Clin Electrophysiol

Pays: United States

ID NLM: 101656995

Informations de publication

Date de publication:
03 2019

Historique:

received: 15 06 2018

revised: 11 10 2018

accepted: 15 10 2018

entrez: 23 3 2019

pubmed: 23 3 2019

medline: 3 4 2020

Statut: ppublish

Résumé

This study sought to determine the nature of quinidine use and accessibility in a national network of inherited arrhythmia clinics. Quinidine is an antiarrhythmic medication that has been shown to be beneficial in select patients with Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation. Because of the low prevalence of these conditions and restricted access to quinidine through a single regulatory process, quinidine use is rare in Canada. Subjects prescribed quinidine were identified through the Hearts in Rhythm Organization that connects the network of inherited arrhythmia clinics across Canada. Cases were retrospectively reviewed for patient characteristics, indications for quinidine use, rate of recurrent ventricular arrhythmia, and issues with quinidine accessibility. In a population of 36 million, 46 patients are currently prescribed quinidine (0.0000013%, age 48.1 ± 16.1 years, 25 are male). Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation constituted a diagnosis in 13 subjects (28%), 6 (13%), and 21 (46%), respectively. Overall, 37 subjects (81%) had cardiac arrest as an index event. After initial presentation, subjects experienced 7.47 ± 12.3 implantable cardioverter-defibrillator shocks prior to quinidine use over 34.3 ± 45.9 months, versus 0.86 ± 1.69 implantable cardioverter-defibrillator shocks in 43.8 ± 41.8 months while on quinidine (risk ratio: 8.7, p < 0.001). Twenty-two patients access quinidine through routes external to Health Canada's Special Access Program. Quinidine use is rare in Canada, but it is associated with a reduction in recurrent ventricular arrhythmias in patients with Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation, with minimal toxicity necessitating discontinuation. Drug interruption is associated with frequent breakthrough events. Access to quinidine is important to deliver this potentially lifesaving therapy.

Sections du résumé

OBJECTIVES

This study sought to determine the nature of quinidine use and accessibility in a national network of inherited arrhythmia clinics.

BACKGROUND

Quinidine is an antiarrhythmic medication that has been shown to be beneficial in select patients with Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation. Because of the low prevalence of these conditions and restricted access to quinidine through a single regulatory process, quinidine use is rare in Canada.

METHODS

Subjects prescribed quinidine were identified through the Hearts in Rhythm Organization that connects the network of inherited arrhythmia clinics across Canada. Cases were retrospectively reviewed for patient characteristics, indications for quinidine use, rate of recurrent ventricular arrhythmia, and issues with quinidine accessibility.

RESULTS

In a population of 36 million, 46 patients are currently prescribed quinidine (0.0000013%, age 48.1 ± 16.1 years, 25 are male). Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation constituted a diagnosis in 13 subjects (28%), 6 (13%), and 21 (46%), respectively. Overall, 37 subjects (81%) had cardiac arrest as an index event. After initial presentation, subjects experienced 7.47 ± 12.3 implantable cardioverter-defibrillator shocks prior to quinidine use over 34.3 ± 45.9 months, versus 0.86 ± 1.69 implantable cardioverter-defibrillator shocks in 43.8 ± 41.8 months while on quinidine (risk ratio: 8.7, p < 0.001). Twenty-two patients access quinidine through routes external to Health Canada's Special Access Program.

CONCLUSIONS

Quinidine use is rare in Canada, but it is associated with a reduction in recurrent ventricular arrhythmias in patients with Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation, with minimal toxicity necessitating discontinuation. Drug interruption is associated with frequent breakthrough events. Access to quinidine is important to deliver this potentially lifesaving therapy.

Identifiants

DOI: 10.1016/j.jacep.2018.10.007 PMID: 30898241

pubmed: 30898241

pii: S2405-500X(18)30827-2

doi: 10.1016/j.jacep.2018.10.007

pii:

doi:

Substances chimiques

Anti-Arrhythmia Agents 0

Quinidine ITX08688JL

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

376-382

Subventions

Organisme : CIHR

ID : MOP-142218

Pays : Canada

Organisme : CIHR

ID : SRG-15-P09-001