Clinical Applications and Untoward Reactions of Chelation in Cardiac Arrhythmias

Soffer, Alfred

doi:10.1001/archinte.1960.03820060076008

Cited by 18 publications

(4 citation statements)

References 12 publications

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“…A technique of wet MYOCARDIAL RESPONSES TO CHELATION ashing using concentrated nitric acid was devised. The results demonstrated that disodium EDTA does not change total serum calcium but rather chelation rearranges the distribution of calcium in the blood so that as the calcium chelate fraction rises, protein-bound and ionic calcium drop markedly (Soffer et al, 1960). Urinary losses of calcium are replaced from bone reservoirs.…”

Section: Serum Calcium Ion Changesmentioning

confidence: 96%

Myocardial Responses to Chelation

Soffer¹,

Toribara²,

Sayman³

1961

Heart

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The phenomena of displacement and immobilization of calcium ions by chelation is being studied in an increasing number of clinical states. Chelation therapy in hypercalcmmia (Holland et al., 1953;Spencer et al., 1956), calcium deposition in coronary arteries (Meltzer et al., 1960) and peripheral vessels (Clarke et al., 1960) and in skin (Muller et al., 1959), and in the treatment of digitalis toxicity (Cohen et al., 1959) are under scrutiny and therefore careful analysis of the myocardial action of chelating drugs is warranted. In a 28-month study, 125 intravenous infusions of disodium ethylenediaminetetraacetate (disodium edathamil or EDTA) were administered to 58 subjects. Chelation produced four characteristic though occasionally variable responses of ventricular, atrial, and atrio-ventricular (A-V) junctional tissue: (1) suppression of ectopic ventricular beats and ventricular tachycardia, (2) slight slowing of the sino-atrial pacemaker, (3) improvement of A-V nodal conduction in first degree, second degree, and advanced heart block, and (4) increased automaticity of idioventricular pacemakers in complete heart block. Since the slowest effective rate of administration is the safest rate (Spencer et al., 1952), the total quantity of calcium chelated was determined for periods of administration varying from one-half to eleven hours. METHODSThere were 58 subjects, 17 men and 41 women, with a mean age of 65 years. The arrhythmias present were ventricular premature contractions, 18 patients; atrial fibrillation, 11; complete heart block, 7; first-degree heart block, 6; ventricular tachycardia, 4; second degree heart block, 4; advanced heart block, 2; paroxysmal atrial tachycardia with block, 2; atrial flutter, 1; A-V dissociation with a nodal rate above 70, 2; nodal rhythm with ventricular premature contractions and A-V dissociation, 1. Thirty-two patients had a basic sino-atrial pacemaker and 17 were in a state of digitalis intoxication. The disodium EDTA was given in dosages of from 0 5 g. to 4 g. in periods ranging from one-half hour to 11 hours. In three instances 3 g. were administered in 30 minutes but in all other cases the rate of infusion never exceeded 4 g. in 60 minutes. The drug was diluted in either 500 c.c. or 1000 c.c. of 5 per cent glucose in water. The concentration of the drug was maintained below 0 5 per cent unless congestive failure prohibited the use of dilute solutions. Ultrafiltrable serum calciums were determined by the method of Toribara and Terepka (Toribara et al., 1957). Samples deproteinized with trichloracetic acid were used for determining total serum calcium. Ashing with concentrated nitric acid was necessary to obtain complete recovery of chelated calcium.

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Section: Serum Calcium Ion Changesmentioning

confidence: 96%

Myocardial Responses to Chelation

Soffer¹,

Toribara²,

Sayman³

1961

Heart

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“…Ayant entraîné parfois des accidents mortels, ce test a été dé conseillé par plusieurs auteurs [71,41], A dire vrai, sous surveil lance et avec un Bêta-bloqueur à disposition, il pourrait être avan tageusement introduit dans les services hospitaliers. d) D'autres tests diagnostiques sont peu utilisés, l'infusion de calcium est dangereuse [141] ; les réponses à un chélateur du cal cium (EDTA) ne sont pas spécifiques [125,127,23,73] ; le « Ten-silon », qui vient d'être proposé [106], n'est pas encore d'un usage courant.…”

Section: ° Effets Toxiquesunclassified

“…Parmi d'autres thérapeutiques des troubles rythmiques graves de l'intoxication digitalique, les médicaments suivants sont proposés, qui ont chacun des promoteurs convaincus : a) Le Vcrsenate de sodium (Na2EDTA), chélateur du calcium, extrêmement actif, mais auquel on reproche un effet transitoire et des ennuis secondaires prohibitifs à la longue, voire dangereux [135,39,59,62,128,127,22,3]. b) Le Sulfate de magnésie, solution à 20 % : 20 ml i.v.…”

Section: Le Traitement De L'intoxication Digitaliqueunclassified

Diagnostic de l’intoxication digitalique et son traitement

Ferrero¹

1967

Cardiology

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“…It is not clear that the calcium can be removed from depots in arteries at all, or if it can, why chelating agents should do so without decalcifying bones at the same time. 40 In actual fact, the latter is a well-authenticated complication of the calcium chelators. So also are renal reactions.…”

Section: Fperitrate•mentioning

confidence: 99%

Clinical pharmacology of antianginal drugs

Modell

1962

Clin Pharma and Therapeutics

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The problem of examining and evaluating antianginal effects is explored. Special attention is paid to the mode of action of the nitrites, which form the mainstay of the modern treatment of angina of effort. Other pharmacologic features of these drugs are also examined. Prophylactic therapy is considered, and the improbability of developing an effective long‐acting nitrite is discussed. Other drugs and therapies are also considered: alcohol, sedatives and tranquilizers, khellin, xanthines, hormones, cholesterolytic agents, tissue extracts, anticoagulants, papaverine, and antithyroid drugs. The monamine oxidase inhibitors, the probable mode of their effect in angina, and their uses and dangers are considered in some detail.

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Clinical Applications and Untoward Reactions of Chelation in Cardiac Arrhythmias

Cited by 18 publications

References 12 publications

Myocardial Responses to Chelation

Myocardial Responses to Chelation

Diagnostic de l’intoxication digitalique et son traitement

Clinical pharmacology of antianginal drugs

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