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Suppression of premature ventricular complexes with the PDE5 inhibitor sildenafil: First clinical experience

Hutchings, David C; Denton, Christopher P; Venetucci, Luigi; Trafford, Andrew W; (2025) Suppression of premature ventricular complexes with the PDE5 inhibitor sildenafil: First clinical experience. Experimental Physiology 10.1113/EP092932. (In press). Green open access

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Abstract

The phosphodiesterase-5 inhibitor sildenafil suppresses ventricular arrhythmias in a sheep model of drug-induced long QT. In that study, ventricular arrhythmias were abolished by reducing premature ventricular complexes (PVCs) and delaying PVC onset, thus preventing ‘R-on-T’ ventricular tachycardia. Evidence for effects in humans with arrhythmias is lacking. In this case study, a 50-year-old female with a history of PVCs and systemic sclerosis was started on sildenafil for Raynaud's phenomenon in line with current treatment recommendations. During initiation, the patient wore a 7-day cardiac monitor. Two subtypes of PVCs were observed: one distinct morphology arising <400 ms from the preceding sinus beat (‘early’) and a separate morphology >400 ms from the preceding sinus beat (‘late’). Sildenafil abolished late PVCs and substantially reduced the frequency of early PVCs. Of those early PVCs remaining during sildenafil treatment, PVCs arose later in the cardiac cycle, 21 ms further from the preceding T wave apex. During washout, PVCs returned in frequency and timing towards baseline values. We report the first case suggesting an anti-arrhythmic property of sildenafil in a human.

Type: Article
Title: Suppression of premature ventricular complexes with the PDE5 inhibitor sildenafil: First clinical experience
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1113/EP092932
Publisher version: https://doi.org/10.1113/ep092932
Language: English
Additional information: Copyright © 2025 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society. This is an open access article under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Arrhythmia, phosphodiesterase‐5, sildenafil
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/10214045
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