Approaches to Drug Selection and Serial Drug Testing
The evaluation of antiarrhythmic therapy is predicated on the availability of effective means of measuring cardiovascular arrhythmias and determining a drug effect. There are a number of techniques which exist for arrhythmia detection and to aid in therapy assessment. One of them is the 24 hour Holter ambulatory electrocardiography. This technique has been quite useful and has been reviewed by a number of investigators. Exercise tolerance testing, drug level measurements, and programmed electrical stimulation are other techniques for arrhythmia therapy assessment. Drug level measurements have been demonstrated by Meyerburg and associates to be useful in determining if a Class I agent such as procainamide has been given to an effective level. Patients who have had prior electrical instability, if treated with an effective level of a class I agent, will show a reduced incidence in mortality. Antiarrhythmic drug level measurements may be very helpful in determining complicance with antiarrhythmic therapy, as well as determining if a population will show a reduced incidence of sudden death. But the technique of drug level measurement does not aid us in identifying who is at risk, or whether the antiarrhythmic agent is really benefiting that particular patient. Thus, other techniques for arrhythmia therapy assessment have been looked at.
KeywordsPlacebo Toxicity Catheter Ischemia Attenuation
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