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Disopyramide in Hypertrophic Cardiomyopathy

• Pollick C. Disopyramide in hypertrophic cardiomyopathy. II. Noninvasive assessment after oral administration. American Journal of Cardiology 1988;62(17):1252-5
  The effects of oral disopyramide 150 mg 4 times a day were compared with propranolol 40 mg 4 times a day and placebo in 10 patients with hypertrophic cardiomyopathy and resting obstruction (7 patients) or latent obstruction (3 patients), in a randomized double-blind crossover design; each drug was given for a period of 4 days. As determined from echocardiographic evaluation of systolic anterior motion of the mitral valve, the subaortic pressure gradient was decreased from 61 +/- 20 mm Hg with placebo to 5 +/- 15 mm Hg with disopyramide (p less than 0.01), and 30 +/- 30 mm Hg with propranolol (p less than 0.01). Disopyramide was more effective than propranolol (p less than 0.01). Disopyramide and propranolol both shortened left ventricular ejection time from 352 +/- 51 ms with placebo to 314 +/- 26 and 322 +/- 41 ms, respectively (p less than 0.01). Preejection period was lengthened from 93 +/- 35 ms with placebo to 119 +/- 25 ms with disopyramide, but was unchanged by propranolol at 98 +/- 23 ms. Disopyramide increased exercise duration versus placebo (10.4 +/- 2 vs 9.6 +/- 2 minutes, respectively (p less than 0.05), whereas propranolol produced no significant change (8.8 +/- 2 minutes).
• Pollick C, Kimball B, Henderson M, Wigle ED. Disopyramide in hypertrophic cardiomyopathy. I. Hemodynamic assessment after intravenous administration. American Journal of Cardiology 1988;62(17):1248-51
  The hemodynamic effects of intravenous disopyramide were determined in 43 patients with hypertrophic cardiomyopathy and pressure gradients at rest (resting obstruction). The basal subaortic pressure gradient decreased in all patients by a mean of 61 mm Hg (range 16 to 123); in 35 patients the gradient was abolished (less than 20 mm Hg). The reduction in pressure gradient was achieved through a decrease in left ventricular systolic pressure, from 178 to 135 mm Hg (p less than 0.0001), and a rise in aortic systolic pressure, from 105 to 123 mm Hg (p less than 0.0001). Left ventricular ejection time was reduced from 326 to 273 ms (p less than 0.0001). Left ventricular end-diastolic pressure decreased from 19 to 16 mm Hg (p less than 0.0001). In a subgroup of 13 patients, cardiac output was unchanged after disopyramide, despite a prolongation of the pre-ejection period from 104 to 137 ms (p less than 0.0001) indicating a decrease in contractility. The maintenance of cardiac output, despite a decrease in contractility, may reflect a decrease in mitral regurgitation resulting from the reduction of systolic anterior motion of the mitral valve by disopyramide. These results indicate that disopyramide produces predictably favorable hemodynamic effects in patients with hypertrophic cardiomyopathy and resting obstruction to left ventricular outflow.
• Pollick C. Muscular subaortic stenosis: hemodynamic and clinical improvement after disopyramide. New England Journal of Medicine 1982;307(16):997-9

Colchicine for Recurrent Pericarditis

The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases.

The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy.

Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment.

In the largest multicenter international study - 51 patients were treated with colchicine to prevent further relapses and were followed up for up to 10 years.

The evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases.

Circulation 1998 Jun 2;97(21):2183-5

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