Quinidine, a life-saving medication for brugada syndrome, is inaccessible in many countries

Sami Viskin, Arthur A M Wilde, Milton E. Guevara-Valdivia, Amin Daoulah, Andrew D. Krahn, Douglas P. Zipes, Amir Halkin, Kalyanam Shivkumar, Noel G. Boyle, Arnon Adler, Bernard Belhassen, Edgardo Schapachnik, Farhan Asrar, Raphael Rosso

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2383-2387
Number of pages5
JournalJournal of the American College of Cardiology
Volume61
Issue number23
DOIs
StatePublished - Jun 11 2013

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Brugada Syndrome
Quinidine
Cardiac Arrhythmias
Physicians
Medical Societies

Keywords

  • arrhythmic storm
  • Brugada syndrome
  • idiopathic ventricular fibrillation
  • implantable cardioverter-defibrillator
  • quinidine
  • ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Viskin, S., Wilde, A. A. M., Guevara-Valdivia, M. E., Daoulah, A., Krahn, A. D., Zipes, D. P., ... Rosso, R. (2013). Quinidine, a life-saving medication for brugada syndrome, is inaccessible in many countries. Journal of the American College of Cardiology, 61(23), 2383-2387. https://doi.org/10.1016/j.jacc.2013.02.077

Quinidine, a life-saving medication for brugada syndrome, is inaccessible in many countries. / Viskin, Sami; Wilde, Arthur A M; Guevara-Valdivia, Milton E.; Daoulah, Amin; Krahn, Andrew D.; Zipes, Douglas P.; Halkin, Amir; Shivkumar, Kalyanam; Boyle, Noel G.; Adler, Arnon; Belhassen, Bernard; Schapachnik, Edgardo; Asrar, Farhan; Rosso, Raphael.

In: Journal of the American College of Cardiology, Vol. 61, No. 23, 11.06.2013, p. 2383-2387.

Research output: Contribution to journalArticle

Viskin, S, Wilde, AAM, Guevara-Valdivia, ME, Daoulah, A, Krahn, AD, Zipes, DP, Halkin, A, Shivkumar, K, Boyle, NG, Adler, A, Belhassen, B, Schapachnik, E, Asrar, F & Rosso, R 2013, 'Quinidine, a life-saving medication for brugada syndrome, is inaccessible in many countries', Journal of the American College of Cardiology, vol. 61, no. 23, pp. 2383-2387. https://doi.org/10.1016/j.jacc.2013.02.077
Viskin, Sami ; Wilde, Arthur A M ; Guevara-Valdivia, Milton E. ; Daoulah, Amin ; Krahn, Andrew D. ; Zipes, Douglas P. ; Halkin, Amir ; Shivkumar, Kalyanam ; Boyle, Noel G. ; Adler, Arnon ; Belhassen, Bernard ; Schapachnik, Edgardo ; Asrar, Farhan ; Rosso, Raphael. / Quinidine, a life-saving medication for brugada syndrome, is inaccessible in many countries. In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 23. pp. 2383-2387.
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abstract = "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.",
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AU - Wilde, Arthur A M

AU - Guevara-Valdivia, Milton E.

AU - Daoulah, Amin

AU - Krahn, Andrew D.

AU - Zipes, Douglas P.

AU - Halkin, Amir

AU - Shivkumar, Kalyanam

AU - Boyle, Noel G.

AU - Adler, Arnon

AU - Belhassen, Bernard

AU - Schapachnik, Edgardo

AU - Asrar, Farhan

AU - Rosso, Raphael

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N2 - 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.

AB - 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.

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