Quinidine, A Life-Saving Medication for Brugada?Syndrome,?Is Inaccessible in Many Countries

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• 作者：Sami Viskin ; MD^* ; ^{samiviskin@gmail.com} ; Arthur A.M. Wilde ; MD^&dagger ; ; Milton E. Guevara-Valdivia ; MD^&Dagger ; ; Amin Daoulah ; MD^§ ; ; Andrew D. Krahn ; MD^? ; Douglas P. Zipes ; MD^¶ ; ; Amir Halkin ; MD^* ; Kalyanam Shivkumar ; MD ; PhD^# ; Noel G. Boyle ; MD ; PhD^# ; Arnon Adler ; MD^* ; Bernard Belhassen ; MD^* ; Edgardo Schapachnik ; MD^** ; Farhan Asrar ; MD ; MSc ; MPH^&dagger ; &dagger ; ; Raphael Rosso ; MD^*
• 关键词：arrhythmic storm ; Brugada syndrome ; idiopathic ventricular fibrillation ; implantable cardioverter-defibrillator ; quinidine ; ventricular fibrillation
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：11 June, 2013
• 年：2013
• 卷：61
• 期：23
• 页码：2383-2387
• 全文大小：648 K

文摘

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Objectives

The aim of this study was to determine the availability of quinidine throughout the world.

Background

Quinidine is the only oral medication that is effective for preventing life-threatening ventricular arrhythmias due to Brugada syndrome and idiopathic ventricular fibrillation. However, because of its low price and restricted indication, this medication is not marketed in many countries.

Methods

We conducted a survey of the availability of quinidine by contacting professional medical societies and arrhythmia specialists worldwide. Physicians were e-mailed questionnaires requesting information concerning the quinidine preparation available at their hospital. We also requested information concerning cases of adverse arrhythmic events resulting from unavailability of quinidine.

Results

A total of 273 physicians from 131 countries provided information regarding the availability of quinidine. Quinidine was readily available in 19 countries (14 % ), not accessible in 99 countries (76 % ), and available only through specific regulatory processes that require 4 to 90 days for completion in 13 countries (10 % ). We were able to gather information concerning 22 patients who had serious arrhythmias probably related (10 cases) or possibility related (12 cases) to the absence of quinidine, including 2 fatalities possibly attributable to the unavailability of quinidine.

Conclusions

The lack of accessibility of quinidine is a serious medical hazard at the global level.