The possibility of using screening testing for antiarrhythmic medication for ventricular premature complexes differential therapy selection in patients without cardiac structural changes
Objective. To determine the differential therapy of ventricular extrasystoles (VEs) in patients without cardiac structural changes by screening testing of antiarrhythmic drugs. Materials and Methods. The study included 214 patients without cardiac structural changes aged 19 to 45 years with VE III-V classes, according to B. Rayn classification with subjective sensation of arrhythmia and preserved contractile function of the heart. All patients underwent daily electrocardiography monitoring, followed by the selection of potentially effective antiarrhythmic drugs for VEs elimination using screening testing method. The method considered potentially effective when corrected extrasystole index increased by≥2 relative units after the third dose of medication compared with the initial data. The accuracy of the choice (AC) was evaluated according to daily electrocardiography monitoring after a short course of therapy for each tested antiarrhythmic medication for at least 5 days. In case of antiarrhythmic activity of several medications in one patient, a medication with the most pronounced VE number reduction compared with the initial data after a short course of therapy was selected to eliminate ectopic beat. The endpoint of observation was the duration of preserved positive antiarrhythmic effect of the antiarrhythmic medication. Results. 50.47% of patients had positive antiarrhythmic effect of two, 38.32%-of three, and the rest-of four antiarrhythmic medications. AC of potentially effective drugs for eliminating VE in patients without cardiac structural changes was over 90%. In 79.90% of patients, positive antiarrhythmic effect of VE therapy persisted for over 1 year (an average of 3.8±0.08 years). The duration of positive clinical effect for 1 year and higher correlated with the positive results of screening testing of antiarrhythmic drugs (r= 0.94). Conclusion. All patients without cardiac structural changes with VE had potential positive antiarrhythmic effect for 2 and more drugs. AC of potentially effective drugs for elimination of VE in these patients averaged over90%.