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Coppini R, Ferrantini C, Pioner JM, Santini L, Wang ZJ, Palandri C, Scardigli M, Vitale G, Sacconi L, Stefàno P, Flink L, Riedy K, Pavone FS, Cerbai E, Poggesi C, Mugelli A, Bueno-Orovio A, Olivotto I, Sherrid MV. Electrophysiological and Contractile Effects of Disopyramide in Patients With Obstructive Hypertrophic Cardiomyopathy: A Translational Study. JACC Basic Transl Sci 2019; 4:795-813. [PMID: 31998849 PMCID: PMC6978554 DOI: 10.1016/j.jacbts.2019.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/26/2023]
Abstract
In patients with HCM and symptomatic LVOT-obstruction, first treatment with disopyramide leads to a marked reduction of LVOT gradients, with a slight decrease of resting ejection fraction and a modest increase of corrected QT interval, highlighting high efficacy and safety. In single cardiomyocytes and intact trabeculae from surgical samples of patients with obstructive HCM, in vitro treatment with 5 μmol/l disopyramide lowered force and Ca2+ transients while reducing action potential duration and the rate of arrhythmic afterdepolarizations. These effects are mediated by the combined inhibition of peak and late Na+ currents, L-type Ca2+ current, delayed-rectifier K+ current, and ryanodine receptors. In addition to the negative inotropic effect of disopyramide, in vitro results suggest additional antiarrhythmic actions.
Disopyramide is effective and safe in patients with obstructive hypertrophic cardiomyopathy. However, its cellular and molecular mechanisms of action are unknown. We tested disopyramide in cardiomyocytes from the septum of surgical myectomy patients: disopyramide inhibits multiple ion channels, leading to lower Ca transients and force, and shortens action potentials, thus reducing cellular arrhythmias. The electrophysiological profile of disopyramide explains the efficient reduction of outflow gradients but also the limited prolongation of the QT interval and the absence of arrhythmic side effects observed in 39 disopyramide-treated patients. In conclusion, our results support the idea that disopyramide is safe for outpatient use in obstructive patients.
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Key Words
- AP, action potential
- DAD, delayed afterdepolarization
- EAD, early afterdepolarization
- ECG, electrocardiography
- HCM, hypertrophic cardiomyopathy
- ICa-L, L-type Ca current
- IK, delayed-rectifier K current
- INaL, late Na current
- LVOT, left ventricular outflow tract
- NCX, Na+/Ca2+ exchanger
- QT interval
- RyR, ryanodine receptor
- SR, sarcoplasmic reticulum
- action potentials
- arrhythmias
- diastolic dysfunction
- hERG, human ether-à-go-go-related gene
- hypertrophic cardiomyopathy
- pCa, Ca activation level
- safety
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Affiliation(s)
| | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Josè Manuel Pioner
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Santini
- Department NeuroFarBa, University of Florence, Florence, Italy
| | - Zhinuo J Wang
- Department of Computer Sciences, University of Oxford, Oxford, United Kingdom
| | - Chiara Palandri
- Department NeuroFarBa, University of Florence, Florence, Italy
| | - Marina Scardigli
- European Laboratory for Nonlinear Spectroscopy (LENS), University of Florence, Sesto Fiorentino, Italy and National Institute of Optics, National Research Council, Florence, Italy
| | - Giulia Vitale
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Leonardo Sacconi
- European Laboratory for Nonlinear Spectroscopy (LENS), University of Florence, Sesto Fiorentino, Italy and National Institute of Optics, National Research Council, Florence, Italy
| | - Pierluigi Stefàno
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Laura Flink
- Division of Cardiology, San Francisco Veterans Affairs Medical Center and University of California-San Francisco, San Francisco, California
| | - Katherine Riedy
- Hypertrophic Cardiomyopathy Program, New York University Langone Health, New York, New York
| | - Francesco Saverio Pavone
- European Laboratory for Nonlinear Spectroscopy (LENS), University of Florence, Sesto Fiorentino, Italy and National Institute of Optics, National Research Council, Florence, Italy
| | | | - Corrado Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, New York University Langone Health, New York, New York
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Ekelund LG, Nilsson E, Walldius G. Efficacy of and adverse effects of disopyramide. Comparison of capsules, controlled release tablets and placebo in patients with chronic ventricular arrhythmias. Eur J Clin Pharmacol 1986; 29:673-7. [PMID: 3519236 DOI: 10.1007/bf00615957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The efficacy of disopyramide compared to placebo for exercise induced ventricular arrhythmias was tested in a double-blind randomized controlled clinical trial with cross-over design in 14 patients with coronary heart disease. Disopyramide was given as ordinary capsules (q.i.d.) or as a slow release preparation (b.i.d.) in a total dose of 600 mg per day. The placebo preparations were identical looking capsules and tablets. Each treatment period lasted one week. Efficacy was assessed by a standardized exercise test on a bicycle ergometer and a 6-h Holter monitoring at the end of each period. Plasma levels of disopyramide, measured in conjunction with exercise test, fell within therapeutic range, with a mean value of 7.9 and 8.9 mumol/l for capsules and slow release tablets, respectively. Disopyramide gave a marked and significant reduction of ventricular ectopic beats both at rest and during and after exercise. There was also a significant decrease in the number of ectopic beats recorded on tape during treatment periods compared to during placebo periods. There were no differences between the two preparations with respect to antiarrhythmic effect. Only mild side-effects, mainly mild anticholinergic symptoms, similar for both preparations were reported. No significant cardiovascular changes (heart rate and blood pressure response) were observed.
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