Cardiac Arrhythmias: New Therapeutic Drugs and Devices

In summary, there are many animal models that are useful in selecting new antiarrhythmic drugs. The selection of which model is most idea depends upon precisely what question is being asked. The large number of experimental models used to evaluate antiarrhythmic compounds points out the inability of anyone model to define the probability of antiarrhythmic efficacy in man. It has therefore become standard practice to utilize a batter of animal models for the evaluation of new antiarrhythmic agents. Each model has its own advantages and disadvantages and it is necessary to understand each model fully in oder to evaluate experimental findings and apply them to clinical settings. We believe that the availability of the chronic myocardial infarction ventricular tachyarrhythmia model provides 1) an excellent opportunity to more precisely understand arrhythmia mechanisms, 2) to develop new techniques such as signal averaging for evaluating late low level potentials identifying hearts at high risk of sudden death 3) to identify new antifibrillatory drugs versus drugs that are effective primarily against PVC's and ventricular tachycardia 4) to identify new surgical techniques to eliminate VT/VF, and 5) to evaluate new pacing modalities including implantable cardioverters. Although all animal models are wrong, many are very useful in furthering our knowledge directed at decreasing the distressingly high mortality from heart disease. NORMAL HtART TACHYCMDIA HtART , .. '" \ I I I I I I I I I .

Inhalt

I Basic Considerations.- 1 What animal models are useful in selecting new antiarrhythmic drugs?.- 2 How to test for antiarrhythmic drugs.- 3 Initial evaluation of new antiarrhythmic agents in man: normal volunteers or patients?.- 4 Is there a rational basis for the modified classification of antiarrhythmic drugs?.- Panel Discussion: Basic considerations.- II Status of Specific Antiarrhythmic Agents.- 5 Procainamide, Quinidine, Disopyramide, Cibenzoline, Pirmenol - efficacy in the treatment of ventricular arrhythmias: current status and controversies.- 6 Mexiletine, Tocainide and Ethmozine: newer class I antiarrhythmic agents.- 7 Class IC antiarrhythmic agents: status - 1984.- 8 Role of beta-blocking agents in the treatment of ventricular arrhythmias.- 9 Status of class III antiarrhythmic drugs: Amiodarone, Bretylium and Sotalol.- Panel Discussion: Status of specific antiarrhythmic agents.- III Special Considerations and FDA Standards.- 10 Some thoughts on efficacy trials of antiarrhythmic agents: pitfalls of mimicking clinical practice.- 11 Use of a computer in the new drug evaluation process.- 12 Sudden cardiac death - failure or effect of antiarrhythmic drug therapy?.- 13 Sudden death as an end-point for the clinical evaluation of antiarrhythmic drugs.- 14 Holter/exercise and electrophysiologic methods forevaluating drug therapy for malignant ventricular arrhythmias: do we need both models?.- Panel Discussion: Special considerations and FDA standards.- IV New Antiarrhythmic Devices.- 15 DVI vs DDD pacemakers - proarrhythmic or antiarrhythmic?.- 16 Pacing for ventricular tachycardia.- 17 Termination of ventricular tachycardia by transvenous cardioversion.- 18 The automatic implantable cardioverter/defibrillator.- 19 New antiarrhythmia devices - FDA's requirements for effectiveness.- Panel Discussion: New antiarrhythmic devices.- V Evaluation Of Atrial Arrhythmias.- 20 Study designs to evaluate atrial arrhythmias are easy.- 21 Role of the autonomic nervous system in the generation of supraventricular tachyarrhythmias: clues to drug selection.- 22 Approaches to drug selection and serial drug testing.- Panel Discussion: Evaluation of atrial arrhythmias.- Participants.