Prevention of Sudden Death in Post-MI Patients: What Is the Role of Non-Antiarrhythmic Drugs?

  • D. Bracchetti
  • G. Casella
  • E. Negrini
  • M. G. Camplese
  • P. Sangiorgio


Ventricular arrhythmias have a relevant prognostic significance, particularly when associated with myocardial infarction, ischemic heart disease or congestive heart failure. Unfortunately, very effective antiarrhythmic drugs failed to improve prognosis as shown by the CAST studies. Moreover, their use has been limited by several hazardous side effects such as negative inotropic action and serious proarrhythmia. Furthermore, in ischemic heart disease, the electrophysiological mechanisms responsible for ventricular arrhythmias are complex (reentry, abnormal automaticity, delayed after-depolarization), variable and often interdependent. Besides, concomitant factors as sympathetic hypertone, hypokalemia and acidosis play a crucial role. Thus, clinical indications for antiarrhythmic therapy are still controversial and it could be reasonable to consider, when approaching ventricular arrhythmias, the treatment of concomitant factors and the use of drugs such as fibrinolytic agents, β-blockers and ACE inhibitors, that are not traditionally considered as antiarrhythmic agents.


Acute Myocardial Infarction Angiotensin Convert Enzyme Ventricular Arrhythmia Acute Myocardial Infarction Angiotensin Convert Enzyme Inhibitor 
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  1. 1.
    Podrid PJ (1990) Potassium and ventricular arrhythmias. Am J Cardiol 65 (Suppl E): 33–44CrossRefGoogle Scholar
  2. 2.
    Hulting J (1981) In hospital ventricular fibrillation and its relation to serum potassium. Acta Med Scand 647 (suppl): 109–116Google Scholar
  3. 3.
    Fibrinolytic Therapy Trialists (FTT) Collaborative Group (1994) Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more of 1000 patients. Lancet 343: 311–322Google Scholar
  4. 4.
    Julian D, Braunwald E (1994) Management of acute myocardial infarction. WB Saunders, London, pp 156–157Google Scholar
  5. 5.
    Solomon SD, Ridker PM, Antman EM (1993) Ventricular arrhythmias in trials of thrombolytic therapy for acute myocardial infarction. A meta-analysis. Circulation 88: 2575–2581PubMedCrossRefGoogle Scholar
  6. 6.
    Maggioni AP et al on be half of GISSI-2 Investigators (1993) Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era, GISSI-2 results. Circulation 87:312–322CrossRefGoogle Scholar
  7. 7.
    Kendall MJ, Lynch KP, Hjalmarson A, Kjekshus J (1995) Beta-blockers and sudden cardiac death. Ann Intern Med 123: 358–367PubMedCrossRefGoogle Scholar
  8. 8.
    Held PH, Yusuf S (1993) Effects of beta-blockers and calcium channel blockers in acute myocardial infarction. Eur Heart J 14 (suppl F): 18–23PubMedCrossRefGoogle Scholar
  9. 9.
    Olson G et al (1992) Metoprolol-induced reduction in postinfarction mortality: pooled results from five double-blind randomized trials. Eur Heart J 13: 28–32Google Scholar
  10. 10.
    Kennedy HL et al and the CAST Investigators (1994) Beta-blocker therapy in the Cardiac Arrhythmia Suppression Trial. Am J Cardiol 74:674–680CrossRefGoogle Scholar
  11. 11.
    Siebels J et al and the CASH Investigators (1993) ICD versus drugs in cardiac arrest survivors: preliminary results of the Cardiac Arrest Study Hamburg. PACE 16:552–558CrossRefGoogle Scholar
  12. 12.
    Dean JW, Lab MJ (1989) Arrhythmia in heart failure: role of mechanically induced changes in electrophysiology. Lancet 1: 309–312Google Scholar
  13. 13.
    Campbell RWF (1996) ACE inhibitors and arrhythmias. Heart 76 (suppl 3): 79–82PubMedCrossRefGoogle Scholar
  14. 14.
    Kingma JH et al for the CATS investigators (1994) Acute intervention with captopril during thrombolysis in patients with first anterior myocardial infarction. Results from the Captopril and Thrombolysis Study (CATS). Eur Heart J 15:898–902Google Scholar
  15. 15.
    Ambrosioni E et al for the SMILE Pilot Study Working Party (1991) Early treatment of acute myocardial infarction with angiotensin-converting enzyme inhibition: safety consideration. SMILE Pilot Working Party. Am J Cardiol 68:101D–110DGoogle Scholar
  16. 16.
    The CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316: 1429–1435CrossRefGoogle Scholar
  17. 17.
    Fletcher RD et al for the VHeFT II VA Cooperative Studies Group (1993) Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure. Circulation 87 (suppl VI):VI-49Google Scholar
  18. 18.
    Pfeffer JM et al (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement Trial. N Engl J Med 327: 669–675PubMedCrossRefGoogle Scholar
  19. 19.
    Pratt CM et al for the SOLVD Investigators (1995) Lack of long-term ventricular arrhythmia reduction by enalapril in heart failure. Am J Cardiol 75:1244–1249CrossRefGoogle Scholar
  20. 20.
    Fonarow GC et al (1992) Effect of direct vasodilation with hydralazine versus angiotensin-converting enzyme inhibition with captopril on mortality in advanced heart failure: the Hy-C trial. J Am Coll Cardiol 19: 842–850PubMedCrossRefGoogle Scholar
  21. 21.
    Kober L et al for the Trandolapril Cardiac Evaluation (TRACE) Study Group (1995) A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 333:1670–1676Google Scholar
  22. 22.
    Cleland JGF et al on behalf of the AIRE Study Investigators (1997) Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure. A report from the AIRE Study Investigators. Eur Heart J 18:41–51Google Scholar
  23. 23.
    Sogaard P et al (1994) Ventricular arrhythmias in the acute and chronic phases after acute myocardial infarction. Effect of intervention with captopril. Circulation 90: 101–107PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • D. Bracchetti
    • 1
  • G. Casella
    • 1
  • E. Negrini
    • 1
  • M. G. Camplese
    • 1
  • P. Sangiorgio
    • 1
  1. 1.Sezione di CardiologiaOspedale MaggioreBolognaItaly

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