Heart Rhythm Congress October GUCH Arrhythmias. why, what and which drugs are best. Dr Graham Stuart Bristol Congenital Heart Unit
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1 Heart Rhythm Congress October 2016 why, what and which drugs are best Dr Graham Stuart Bristol Congenital Heart Unit
2 why, what,which drugs are best Digitalis 1785 Withering W An account of the Foxglove and its medical uses. Birmingham England 1785
3 why, what,which drugs are best Digitalis 1785 Wiithering W An account of the Foxglove and its medical uses Withering W An account of the Foxglove and its medical uses. Birmingham England 1785
4 why, what,which drugs are best Digitalis 1785 Wiithering W An account of the Foxglove and its medical uses DC Ablation 1982 Gallagher et al Catheter technique for closed chest ablation NEJM
5 why, what, which drugs are best
6 why, what, which drugs are best
7 why, what, which drugs are best When / what drugs should we not use Drugs for Supraventricular arrhythmias Drugs for Ventricular arrhythmias Do patients take the drugs we prescribe
8 why, what, which drugs are best When / what drugs should we not use Drugs for Supraventricular arrhythmias Drugs for Ventricular arrhythmias Do patients take the drugs we prescribe
9 drugs we should not use John Moore s University
10 Cole et al 2015 Street drugs contaminants, adulterants, bulking agents Clembuterol Dextromorphine Dexamphetamine Lidocaine/procaine Strychnine Diltiazem Ketamine Ephedrine scopolamine Lead Glass Aluminium Talc C Botulinum C cereus B anthracis cyanide
11 Energy Drinks 30% of 12-19yr olds regularly consume energy drinks > 5000 overdoses per annum in USA Similar caffeine content to percolated coffee (90mg) Caffeine = guaranine=theine=maurine Sanchis-Gomar et al Can J Cardiol 2015;Energy Drink Overconsumption in Adolescents: Implications for Arrhythmias
12 Energy Drinks Am J Cardiol 2014;114: yr old Man 3 energy drinks after waking tired for morning shift 250mg caffeine..
13 * * CVS effects Normal heart : restrict to one drink per day Sanchis-Gomar ACHD heart :? No safe level. Rx as per coffee * * Canadian Journal of Cardiology 2015:31;572-5 ½ can Red Bull ½ ounce jagermeister
14 4 th March 2015
15 drugs we should not use N Engl J Med 2016;375: Cause endothelial cell death Increase oxidative stress Toxic to cardiomyoblasts depending on flavour
16 drugs we should not use Negatively inotropic Flecainide Alters pacing thresholds proarrhythmic?
17 flecainide and proarrhythmia CAST study Ischaemic heart disease study (50% EF <40%) ( arrhythmia event rate = placebo if EF >40%) Conversion of afib to conducted atrial tachycardia use with av node blocker Interactions - Cytochrome P450 eg statins, prozac, citalopram
18 flecainide and proarrhythmia Ped Cardiol 2015;36: hospitals PHID Pediatric health Information database 3,144 children 0-18yrs 229 on flecainide 126 deaths! 60 Cardiac arrests No difference in incidence Of deaths / cardiac arrest Flecainide / other drugs
19 flecainide and proarrhythmia Ped Cardiol 2015;36: Flecainide may be reasonable option in some ACHD patients if ventricular function good
20 why, what, which drugs are best When / what drugs should we not use Drugs for Supraventricular arrhythmias Drugs for Ventricular arrhythmias Do patients take the drugs we prescribe
21 Koyak Z et al Am J Cardiol 2013;112: Multicentre study/ retrospective Efficacy of AAD in SVT CONCOR Database All new onset SVT in ACHD excluded non cardiac causes of arrhythmia eg hypot4
22 Koyak Z et al Am J Cardiol 2013;112: Others n= Septal defects LVOT
23 Koyak Z et al Am J Cardiol 2013;112: Mean age 51 yrs 73% post-op. Sick patients 62% comorbidity Poor ventricles 5-10% Big atria >50%
24 Koyak Z et al Am J Cardiol 2013;112:
25 Koyak Z et al Am J Cardiol 2013;112:
26 Koyak Z et al Am J Cardiol 2013;112: Side effects / recurrence 22% had side effects 75% on class III drugs 85% changed AAD 22% adverse events Pacemaker 9, admission 8 Death 2, CVA 1 50% recurred by 2yrs 80% recurred by 4 years
27 Koyak Z et al Am J Cardiol 2013;112: Ablation 26 ablations in 23 patients Mostly after 1 st recurrence - RF in 31% - others Maze/mini maze - 55% Afib +AVRT/Flutter/AVNRT Acute success 78% (67% at 1yr)
28 Sotolol best! Koyak Z et al Am J Cardiol 2013;112:
29 Koyak Z et al Am J Cardiol 2013;112: Conclusion Class III most effective for SR Sotolol should be Ist choice for SVT
30 Thromboprophylaxis in adults with CHD and IART /AFib Heart Rhythm 2014:11(10):
31 why, what, which drugs are best When / what drugs should we not use Drugs for Supraventricular arrhythmias Drugs for Ventricular arrhythmias Do patients take the drugs we prescribe
32 ventricular tachycardia- which drugs are best - Evidence free zone - Treat haemodynamics - Try a beta blocker if symptoms rarely helps.. - Consider ICD/ablation
33 why, what, which drugs are best If it doesn t make your patient feel better or live longer DON T do it!
34 why, what, which drugs are best When / what drugs should we not use Drugs for Supraventricular arrhythmias Drugs for Ventricular arrhythmias Do patients take the drugs we prescribe
35 Circulation 2009;119: No Data in ACHD After Myocardial infarction 25% stopped taking some drugs by day 7 34% stopped >1 drug by 1 month 12% stopped ALL drugs by 1 month
36 Drugs are not without problems!
37 why, what, which drugs are best When / what drugs should we not use Drugs for Supraventricular arrhythmias Drugs for Ventricular arrhythmias Do patients take the drugs we prescribe
38 why, what and which drugs are best? Maybe, with the right ablation techniques we might not need drugs
39 Any Questions?
40
41 Drugs for SVT Flecainide Propafenone Digoxin Propranolol / Bisoprolol / Atenolol/ metoprolol Amiodarone Mexilitine Sotolol Use drugs you are familiar with (dose/side effects ) Ped Cardiol 2015;36:
42 why, what,which drugs are best Rosenthal Lowe Ernst
Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification
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