What is the role of medications in the treatment of ventricular premature complexes (VPCs) following myocardial infarction?

Updated: Nov 26, 2016
  • Author: Jatin Dave, MD, MPH; Chief Editor: Jose M Dizon, MD  more...
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Answer

Class III drugs (eg, amiodarone, sotalol) are approved for use only in life-threatening arrhythmia. Recent data suggest that amiodarone is safe post-MI for patients with VPCs, but does not reduce mortality. Amiodarone is the drug of choice in patients who can not tolerate beta-blockers. A meta-analysis comparing efficacy and safety of amiodarone and metoprolol in the treatment of VPC concluded that the response rate of amiodarone did not seem to be superior to metoprolol; amiodarone was associated with higher incidence of adverse reactions. [25, 26]

Class IV drugs (calcium channel blockers), in general, have a limited role in the treatment of VPCs. However, occasionally, these drugs may suppress triggered automaticity or idiopathic VPCs. Verapamil is recommended for treatment of idopathic LVOT VPCs. 

Currently, no evidence supports treatment of asymptomatic VPCs after MI with medication other than beta-blockers. Treatment considerations include symptoms caused by VPC, other prognostic variables (ie, presence or absence and type of structural heart disease, CAD, and LV dysfunction), and adverse effects (specifically proarrhythmic effects of medications).

Clinical trials have suggested that type I antiarrhythmic agents and racemic sotalol increase mortality in patients post-MI. Amiodarone may have no adverse effect on mortality in this setting. [27]


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