1
|
Mazzanti A, Tenuta E, Marino M, Pagan E, Morini M, Memmi M, Curcio A, Monteforte N, Bloise R, Napolitano C, Bagnardi V, Priori SG. 6081Efficacy and limitations of quinidine therapy in patients with Brugada Syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Quinidine at high-dose is used in patients with Brugada Syndrome (BrS), but its efficacy to prevent life-threatening arrhythmic events (LAE) in BrS is unproven and its use is limited by side effects.
Objective
We assessed whether low-dose quinidine in BrS patients reduces: 1) the occurrence of a first LAE; 2) the arrhythmic burden in the high-risk group of cardiac arrest survivors.
Methods
We first compared the clinical course of 53 BrS patients treated with quinidine to that of 441 untreated controls, matched by sex, age, and symptoms. Furthermore, we calculated the annual incidence of LAEs off- and on-quinidine in 123 BrS patients who had survived a cardiac arrest.
Results
First, we compared the clinical course of 53 BrS patients treated with quinidine (i.e. “cases”: 89% males, median age 40 years) to that of 441 untreated, clinically-matched BrS patients (i.e. “controls”: 91% males, median age 41 years) present in our database of patients with inherited arrhythmias. Cases received quinidine (median dose of 450 mg per day) for 5.0±3.7 years. Quinidine was interrupted in only 3/53 cases (6%) for side effects and it conferred a nonsignificant reduction of the risk of a first LAE in cases versus controls (HR 0.74, 95% CI 0.22–2.48, P=0.62).
Secondly, we calculated the annual recurrence of LAE off- and on-quinidine in 123 BrS cardiac arrest survivors, 27 of whom were treated with quinidine for 7.0±3.5 years. The annual rate of recurrent LAEs decreased significantly from 14.7% while off-quinidine to 3.9% while on-quinidine (P=0.03). Notably, recurrent life-threatening arrhythmic events were recorded in 4/27 (15%) symptomatic patients while on-quinidine.
Conclusion
We demonstrated for the first time in the long-term that low-dose quinidine reduces the recurrence of life-threatening arrhythmias in symptomatic BrS patients, with few side effects. Remarkably, about one-fifth of symptomatic patients experience life-threatening arrhythmias while on-treatment, suggesting that quinidine cannot replace implantable defibrillators in high-risk subjects.
Collapse
Affiliation(s)
| | - E Tenuta
- ICS Maugeri - IRCCS, Pavia, Italy
| | - M Marino
- ICS Maugeri - IRCCS, Pavia, Italy
| | - E Pagan
- University of Milan-Bicocca, Department of Statistics and Quantitative Methods, Milan, Italy
| | - M Morini
- ICS Maugeri - IRCCS, Pavia, Italy
| | - M Memmi
- ICS Maugeri - IRCCS, Pavia, Italy
| | - A Curcio
- ICS Maugeri - IRCCS, Pavia, Italy
| | | | - R Bloise
- ICS Maugeri - IRCCS, Pavia, Italy
| | | | - V Bagnardi
- University of Milan-Bicocca, Department of Statistics and Quantitative Methods, Milan, Italy
| | | |
Collapse
|
2
|
Welland MJ, Tenuta E, Prudil AA. Linearization-based method for solving a multicomponent diffusion phase-field model with arbitrary solution thermodynamics. Phys Rev E 2017; 95:063312. [PMID: 28709322 DOI: 10.1103/physreve.95.063312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 11/07/2022]
Abstract
This article describes a phase-field model for an isothermal multicomponent, multiphase system which avoids implicit interfacial energy contributions by starting from a grand potential formulation. A method is developed for incorporating arbitrary forms of the equilibrium thermodynamic potentials in all phases to determine an explicit relationship between chemical potentials and species concentrations. The model incorporates variable densities between adjacent phases, defect migration, and dependence of internal pressure on object dimensions ranging from the macro- to nanoscale. A demonstrative simulation of an overpressurized nanoscopic intragranular bubble in nuclear fuel migrating to a grain boundary under kinetically limited vacancy diffusion is shown.
Collapse
Affiliation(s)
- M J Welland
- Fuel & Fuel Channel Safety, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada, K0J 1J0
| | - E Tenuta
- Fuel & Fuel Channel Safety, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada, K0J 1J0.,Department of Materials Science and Engineering, McMaster University, Hamilton, Ontario, Canada, L8S 4L8
| | - A A Prudil
- Fuel & Fuel Channel Safety, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada, K0J 1J0
| |
Collapse
|
3
|
Abstract
Degradation of hybrid halide perovskites under the influence of environmental factors impairs future prospects of using these materials as absorbers in solar cells. First principle calculations can be used as a guideline in search of new materials, provided we can rely on their predictive capabilities. We show that the instability of perovskites can be captured using ab initio total energy calculations for reactants and products augmented with additional thermodynamic data to account for finite temperature effects. Calculations suggest that the instability of CH3NH3PbI3 in moist environment is linked to the aqueous solubility of the CH3NH3I salt, thus making other perovskite materials with soluble decomposition products prone to degradation. Properties of NH3OHPbI3, NH3NH2PbI3, PH4PbI3, SbH4PbI3, CsPbBr3, and a new hypothetical SF3PbI3 perovskite are studied in the search for alternative solar cell absorber materials with enhanced chemical stability.
Collapse
Affiliation(s)
- E Tenuta
- Department of Materials Science and Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - C Zheng
- Department of Materials Science and Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - O Rubel
- Department of Materials Science and Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| |
Collapse
|