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The sicilian gambit: A new approach to the classification of antiarrhythmic drugs
10
Pharmacological Research, Vol. 26, Supplement 1, 1992
CELLULAR MEcIiANIsMs Elisabetta Institute
OF ARwmTHMIAs
Cerbai and Alessandro Mugelli of Pharmacology, University of
Ferrara,
ITALY
A new approach to the classification of antiarrhythmic drugs has been recently proposed (1). The knowledge of the arrhythmogenic mechanisms is central for this classification, since it is based on a strictly related concept: the "vulnerable parameter", that is, the parameter whose modification is able to terminate the arrhythmia or to prevent its initiation. Examples of the arrhythmogenic mechanisms will be presented, describing the associated alterations in the electrophysiological properties; the vulnerable parameters will be identified. We will focus on recent data we obtained in our laboratory, demonstrating the involvement of triggered activity based on early and delayed afterdepolarizations (EAD and DAD) in reperfusion arrhythmias. The electrophysiological alterations leading to EAD and DAD have been studied in patchclamped ventricular myocytes, with the purpose to identify the ionic changes involved in these events. References: lThe Sicilian Gambit, Circulation, 84:1831, 1991 and Eur Heart J 12:1112, 1991.
THE SICILIAN GAMBIT: A NEW APPROACHTO THE CLASSIFICATION OFANTIARRHYTHMIC DRUGS. PETER J. SCHWARTZ DEPARTMENTOF MEDICINE - UNIVERSITY OF PAVIA - PAVIA, ITALY Suppression Trial results of the Cardiac Arrhythmias The dramatic oversimplistic (CAST) have highlighted the risks inherent to the drugs and have classifications of antiarrhythmic interpretation of the forced a more careful scrutiny of the current clinical thinking about the choices for pharmacological therapy of cardiac arrhythmias. the Working Group on Arrhythmias of the European A Task Force of Society of Cardiology met in Sicily to address the issues related to the The document produced by that classification of antiarrhythmic drugs. (Circulation 1991;84: group, and published as "The Sicilian Gambit" 1831-1851), represents a multifaceted approach and proposes a framework suitable to organize present and future knowledge in a way that is useful to the clinician. The most critical concept, among the many proposed by the "Sicilian Gambit", is that of the "vulnerable parameteru. For each a specific alteration in one or arrhythmogenic mechanism we assume that more electrophysiological properties will be sufficient to terminate or with one minimally associated Among these, the prevent the arrhythmia. undesirable effects is defined as the "vulnerable parameteru.
Pharmacological Research, Vol. 26, Supplement 1, 1992
CELLULAR MEcIiANIsMs Elisabetta Institute
OF ARwmTHMIAs
Cerbai and Alessandro Mugelli of Pharmacology, University of
Ferrara,
ITALY
A new approach to the classification of antiarrhythmic drugs has been recently proposed (1). The knowledge of the arrhythmogenic mechanisms is central for this classification, since it is based on a strictly related concept: the "vulnerable parameter", that is, the parameter whose modification is able to terminate the arrhythmia or to prevent its initiation. Examples of the arrhythmogenic mechanisms will be presented, describing the associated alterations in the electrophysiological properties; the vulnerable parameters will be identified. We will focus on recent data we obtained in our laboratory, demonstrating the involvement of triggered activity based on early and delayed afterdepolarizations (EAD and DAD) in reperfusion arrhythmias. The electrophysiological alterations leading to EAD and DAD have been studied in patchclamped ventricular myocytes, with the purpose to identify the ionic changes involved in these events. References: lThe Sicilian Gambit, Circulation, 84:1831, 1991 and Eur Heart J 12:1112, 1991.
THE SICILIAN GAMBIT: A NEW APPROACHTO THE CLASSIFICATION OFANTIARRHYTHMIC DRUGS. PETER J. SCHWARTZ DEPARTMENTOF MEDICINE - UNIVERSITY OF PAVIA - PAVIA, ITALY Suppression Trial results of the Cardiac Arrhythmias The dramatic oversimplistic (CAST) have highlighted the risks inherent to the drugs and have classifications of antiarrhythmic interpretation of the forced a more careful scrutiny of the current clinical thinking about the choices for pharmacological therapy of cardiac arrhythmias. the Working Group on Arrhythmias of the European A Task Force of Society of Cardiology met in Sicily to address the issues related to the The document produced by that classification of antiarrhythmic drugs. (Circulation 1991;84: group, and published as "The Sicilian Gambit" 1831-1851), represents a multifaceted approach and proposes a framework suitable to organize present and future knowledge in a way that is useful to the clinician. The most critical concept, among the many proposed by the "Sicilian Gambit", is that of the "vulnerable parameteru. For each a specific alteration in one or arrhythmogenic mechanism we assume that more electrophysiological properties will be sufficient to terminate or with one minimally associated Among these, the prevent the arrhythmia. undesirable effects is defined as the "vulnerable parameteru.