Concealed accessory pathway and dual av conduction: Drug‐dependent reentrant tachycardia

Gmeiner, R; Ng, Choi Keung; Gstöttner, Michaela

doi:10.1002/clc.4960020409

Cited by 6 publications

(4 citation statements)

References 11 publications

(23 reference statements)

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“…Calcium antagonists like verapamil and tiapamil slow A -V conduction and, in extreme cases, may even cause sinus or A -V block. This mecha nism may explain the beneficial therapeutic effect o f verapamil [1,13] and tiapamil [3][4][5][6][14][15][16][17][18][19][20], Our experience w-ith tiapamil in pa tients with SVEs is consistent with the results published by other groups.…”

Section: Discussionsupporting

confidence: 82%

Parenteral Tiapamil Treatment of Arrhythmias in Cardiac Patients

Menzel¹,

Kirchner

1982

Cardiology

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27 cardiac patients with different types of arrhythmias were treated in the coronary care unit with tiapamil administered by intravenous infusion. Special attention was given to determining the antiarrhythmic effects in patients with acute coronary insufficiency. In the group of 15 patients with ventricular extrasystoles (VEs; Lown classification III-V), 9 patients had acute myocardial infarction and 1 patient had coronary artery disease. In the group with supraventricular extrasystoles (6 cases), 1 patient had experienced anterior infarction. The third group comprised 6 patients with combined ventricular (Lown V) and supraventricular extrasystoles. In 1 case, the arrhythmia was due to acute anterior infarction, 2 patients had experienced reinfarction and one patient had crescendo angina pectoris. ECG and hemodynamics were monitored continuously before, during and for 20 h following therapy. In patients with VEs alone, the median frequency fell from 612 to 459/h at the third hour of infusion. The median VE/sinus beat quotient decreased from 0.125 to 0.0108 (p < 0.01) in the third hour of treatment, and increased to 0.1029 after the completion of therapy. VE suppression was particularly marked in the 10 patients with coronary artery disease, 7 of these demonstrating a reduction by over 90%. Similar results were obtained in patients with supraventricular arrhythmias and mixed forms.The preliminary results show that tiapamil may be an effective antiarrhythmic agent in supraventricular and particularly in ventricular extrasystoles, and that its spectrum of antiarrhythmic action merits detailed investigation in larger numbers of patients.

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Section: Discussionsupporting

confidence: 82%

Parenteral Tiapamil Treatment of Arrhythmias in Cardiac Patients

Menzel¹,

Kirchner

1982

Cardiology

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“…These results are concordant with the electrophysiological studies by other groups [1][2][3] who have dem onstrated a prolongation of the A-H interval with constant H-V values. Our first results have been confirmed by therapeutic antiar rhythmic effects seen during and after surgery in patients with AF and tachyarrhythmias and in paroxysmal atrial tachycardia [4][5][6]. Dose-response studies have revealed that the administered dose of tiapamil is that re quired to achieve an antiarrhythmic effect with a reduction in A-V conduction rate [7.…”

Section: Discussionsupporting

confidence: 53%

Management of Cardiac Arrhythmias with Tiapamil

et al. 1982

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37 patients with either chronic atrial fibrillation (AF), atrial premature beats (APBs) or ventricular premature beats (VPBs) received tiapamil as antiarrhythmic treatment. Tiapamil reduced A-V conduction by an average 20% in the group with AF (10 patients), the magnitude of response being dependent on the initial ventricular rate. In 3 of the 7 patients with APBs, the frequency of ectopic beats was reduced following a single i.v. injection of 1 mg/kg tiapamil. In patients with VPBs (n = 20), tiapamil (i.v. injection of 1 mg/kg followed by 4-hour i.v. infusion of 50 µg/kg/min in 10 patients) reduced ectopic beats by 30-50% in 6 cases, these all being patients who had not responded to previous antiarrhythmic therapy. The antiarrhythmic effect was maintained by i.v. infusion of 50 µg/kg/min for 4 h. The antiarrhythmic effect of tiapamil consists essentially in slowing A-V conduction and reducing chronic VPBs.

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“…3 c. d) [10]. This case has been published elsewhere and represents the un usual combination of dual antegrade A-V nodal conduction and a concealed accessory pathway [2], Circus movement reentry utiliz ing an accessory pathway was suggested by (a) capture of the atria with a ventricular extra stimulus during tachycardia when the His bundle was refractory (all patients) [7][8][9]11]; (b) increase in V-A interval during tachycar dia with functional bundle branch block ipsilateral to the extranodal accessory pathway (cases 2.4) [8]; (c) fixed V-A conduction time during premature ventricular pacing (all pa tients except case 3) [8], and (d) abnormal ret rograde atrial activation sequence during ta- …”

Section: Electrophysiologic Classification O F Arrhythmiamentioning

confidence: 99%

“…White syndrome [1][2][3][4], The present paper reviews our experience with intravenous tia pamil in patients with concealed accessory pathways.…”

Section: Introductionmentioning

confidence: 99%

Electrophysiology of Tiapamil in Concealed Accessory Pathways

Gmeiner¹,

Ng²

1982

Cardiology

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The effect of 2 mg/kg intravenous tiapamil was studied by programmed stimulation of the heart in 6 patients. Before tiapamil, sustained tachycardias were initiated in 5, and only atrial echoes in 1. In all patients, the reentrant circuit involved an accessory pathway conducting only in the ventriculoatrial direction. When administered during tachycardia, tiapamil promptly terminated the arrhythmia in 5 cases. Tiapamil lengthened the atrio-His (A-H) interval and the effective refractory period of the A-V node. As a result of these changes, it was not possible to initiate the tachycardia in 1 patient. In 1 case, tiapamil permitted the induction of sustained tachycardia, while only echoes had been initiated before the drug. In 2 cases, the tachycardia zone narrowed, in 2 others it widened following tiapamil. The ability to sustain the arrhythmia was lost in 1 patient. Tiapamil may be useful for the termination of reentrant supraventricular tachycardia involving concealed accessory pathways. Whether tiapamil prevents or favors the initiation of tachycardia in these patients depends on the interplay between the prolongation of the effective A-V nodal refractory period and the prolongation of the transnodal conduction time in individual patients.

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Concealed accessory pathway and dual av conduction: Drug‐dependent reentrant tachycardia

Cited by 6 publications

References 11 publications

Parenteral Tiapamil Treatment of Arrhythmias in Cardiac Patients

Parenteral Tiapamil Treatment of Arrhythmias in Cardiac Patients

Management of Cardiac Arrhythmias with Tiapamil

Electrophysiology of Tiapamil in Concealed Accessory Pathways

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