The QUIDAM study: Hydroquinidine therapy for the management of Brugada syndrome patients at high arrhythmic risk

Background Although the implantable cardioverter–defibrillator (ICD) remains the main therapy for Brugada syndrome (BrS), it does not reduce life-threatening ventricular arrhythmia. Based on pathophysiologic mechanisms, hydroquinidine (HQ) has been suggested for effective prevention of arrhythmia. O...

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Veröffentlicht in:	Heart rhythm 2017-08, Vol.14 (8), p.1147-1154
Hauptverfasser:	Andorin, Antoine, MD, Gourraud, Jean-Baptiste, MD, PhD, Mansourati, Jacques, MD, Fouchard, Swanny, PhD, le Marec, Hervé, MD, PhD, Maury, Philippe, MD, Mabo, Philippe, MD, PhD, Hermida, Jean-Sylvain, MD, Deharo, Jean-Claude, MD, Delasalle, Béatrice, MS, Esnault, Simon, MD, Sadoul, Nicolas, MD, Davy, Jean-Marc, MD, PhD, Leenhardt, Antoine, MD, Klug, Didier, MD, Defaye, Pascal, MD, Babuty, Dominique, MD, PhD, Sacher, Frédéric, MD, Probst, Vincent, MD, PhD
Format:	Artikel
Sprache:	eng
Schlagworte:	Adult Anti-Arrhythmia Agents - therapeutic use Brugada Syndrome - complications Brugada Syndrome - physiopathology Brugada Syndrome - therapy Cardiology and cardiovascular system Cardiovascular Cross-Over Studies Defibrillators, Implantable Double-Blind Method Electrocardiography Female Follow-Up Studies Heart Rate - drug effects Human health and pathology Humans Life Sciences Male Middle Aged Pharmaceutical sciences Pharmacology Prospective Studies Quinidine - analogs & derivatives Quinidine - therapeutic use Risk Factors Time Factors Ventricular Fibrillation - etiology Ventricular Fibrillation - physiopathology Ventricular Fibrillation - prevention & control
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Zusammenfassung:	Background Although the implantable cardioverter–defibrillator (ICD) remains the main therapy for Brugada syndrome (BrS), it does not reduce life-threatening ventricular arrhythmia. Based on pathophysiologic mechanisms, hydroquinidine (HQ) has been suggested for effective prevention of arrhythmia. Objective The purpose of this study was to provide evidence-based data supporting HQ use to prevent life-threatening ventricular arrhythmia in high-risk patients with BrS. Methods We performed a prospective multicenter randomized (HQ vs placebo) double-blind study with two 18-month crossover phases in patients with BrS and implanted with an ICD. Results Among the 50 patients enrolled (mean age 47.0 ± 11.4 years, 42 [84%] male), 26 (52%) fully completed both phases. Thirty-four (68%) presented HQ-related side effects, mainly gastrointestinal, which led to discontinuation of the therapy in 13 (26%). HQ lengthened the QTc interval (409 ± 32 ms vs 433 ± 37 ms; P = .027) and increased repolarization dispersion as evaluated by Tpe max in precordial leads (89 ± 15 ms vs 108 ± 27 ms; P
ISSN:	1547-5271 1556-3871
DOI:	10.1016/j.hrthm.2017.04.019