Combined pharmacological therapy including several antiarrhythmic agents for treatment of different disorders of cardiac rhythm

Abstract

Combined therapy using several antiarrhythmic agents can be useful for treatment of different disorders of cardiac rhythm, including their hazardous and stable forms. It is especially re-quired in case of insufficient efficacy after using one antiarrhythmic agent. As a combined therapy one can use the administra-tion of several preparations e.g. 1) preparations of IA subclass and β-blocker adrenergic agents; 2) antiarrhythmic agents of I class and calcium channel blocker agents (verapamil and dil-thiazem); 3) III class (amiodarone or sotalol) together with β-blocker drugs; 4) antiarrhythmic agents of III class and calcium antagonists; 5) antiarrhythmic agents of I and III classes. The latter combination has especially strong effect for treatment of arrhythmias caused by re-entry mechanism with or without a short excitability period. Antiarrhythmic agents of II class (β-blocker drugs) and III classes (amiodarone or sotalol) cause reduction of development risk of arrhythmias with trigger mechanism, including bidirectional spindle-shaped ventricular (torsade de pointes) tachycardia. Thus, combinations including preparations of II class together with III class and simultaneous using of antiarrhythmic agents of I and III classes should be administered to prevent hazardous potentially lethal arrhythmias. The authors of this article have developed a new method of combined therapy of paroxysmal supraventricular tachyarrhythmias in patients with ischemic heart disease, including the use of allapinin and cardiac glycosides. The author’s certificate of invention was obtained for this method. The efficacy of this combined therapy for suppression of supraventricular paroxysmal tachyarrhythmias was analyzed compared to treatment with allapinin alone. It was proved that combined therapy has bigger effectiveness in comparison with therapy with help allapinin only. It is forbidden to use of such combinations of antiarrhythmic agents: β-adrenergic blocker agent + verapamil; β-adrenergic blocker agent + dilthizem; propafenone + verapamil; propafenone + dilthizem; propafenone + β-adrenergic blocker agent. After administration of such combined therapy, it is possible the occurrence medicinal (toxic) disfunction of sinus node. The administration of propafenone together with β-adrenergic blocker agent is impossible because propafenone has properties of β-blocker preparation. It is connected with similar chemical structure of propafenone and non-selective β-blocker agent propranolol.

Авторами статьи разработан новый метод комбинированной терапии пароксизмальных суправентрикулярных тахиаритмий у больных ишемической болезнью сердца, включающий применение аллапинина и сердечных гликозидов. На этот метод получен сертификат на изобретение. Эффективность этой комбинированной терапии для ликвидации пароксизмальных суправентрикулярных тахиаритмий проанализирована в сравнении с терапией одним аллапинином. Доказано, что комбинированная терапия имеет большую эффективность, чем терапия только аллапинином. Противопоказанием являются следующие комбинации антиаритмических препаратов: β-адреноблокаторы + верапамил; β-адреноблокаторы + дилтиазем; пропафенон + верапамил; пропафенон + дилтиазем. После применения комбинированной терапии возможно появление лекарственной (токсической) дисфункции синусового узла. Применение пропафенона совместно с β-адреноблокаторами недопустимо, так как связано с подобной химической структурой пропафенона и неселективного β-адреноблокатора пропранолола.