Effect of adenosine on ventricular parasystole

Tomcsányi, János; Tenczer, József; Horváth, L

doi:10.1016/s0022-0736(96)80114-2

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…18 A report of two patients responding to adenosine has been published. 19 Dilantin was successful in one patient. 20 Cardiac pacing succeeded in two patients.…”

Section: Discussionmentioning

confidence: 94%

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Murray¹

2016

Int J Angiol

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).Ranolazine (RAN) is a novel antianginal agent with antiarrhythmic properties. In the therapeutic concentration range of 2 to 6 μM, RAN inhibits the late sodium current (I Na ), resulting in suppression of early and delayed afterdepolarizations (EAD/DAD), thereby reducing triggered ventricular ectopy. 1 An increase of the late I Na induces EAD/DAD resulting in triggered activity. 2 The diastolic transient inward current in the long QT syndrome 3 is caused by calcium overload and is inhibited by RAN. 3 Because RAN has no known proarrhythmic effects and, to the contrary, protects against torsades de Keywords ► ranolazine ► premature ventricular contractions ► early and delayed afterdepolarizations AbstractEarly and delayed afterdepolarizations (EAD/DAD) cause triggered ventricular ectopy. Because ranolazine (RAN) suppresses EAD/DAD, we postulated that RAN might be effective in reducing premature ventricular contractions (PVCs).To assess the effect of RAN in patients with symptomatic PVCs due to triggered ectopy and its safety and tolerability. A total of 59 patients with symptomatic PVCs were identified from full-disclosure Holters. Doses of 500 and 1,000 mg offlabel RAN, daily, were given to 34 and 66% patients, respectively, and repeat Holters were performed prospectively during mean followup of 3.1 months. The two Holters were retrospectively compared. Congestive heart failure (CHF) was defined as symptoms including dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and fatigue, with a brain natriuretic peptide > 400. Systolic (heart failure with reduced ejection fraction) versus diastolic (heart failure with preserved ejection fraction, HFpEF) CHF depended upon an echocardiographic left ventricular ejection fraction (LVEF) at least 50% by apical two-and four-chamber Simpson's method (HFpEF). The mean age of the patients was 63 years, 60% were males, mean left ventricular ejection fraction was 60%, with 34% having coronary artery disease, 73% were hypertensive, 24% had type 2 diabetic, and 34% were on beta blockers. Upon repeat Holters at a mean of 3.1 months after initiating RAN, 95% (56/59) of the patients had their PVC count reduced as follows: 24% (14/59) had more than 90% decrease, 34% (20/59) had 71 to 90% decrease, and 17% (10/59) had 50 to 70% decrease. In the entire group, RAN reduced PVCs by 71% (mean: 13,329 to 3,837; p < 0.001). Ventricular bigeminy was reduced by 80% (4,168 to 851; p < 0.001), ventricular coupletswere reduced by 78% (374 to 81; p < 0.001), and ventricular tachycardiawas reduced by 91% (56 to 5; p < 0.001). The PVC reduction was dose dependent. Off-label RAN offers an effective and safe pharmacologic treatment for symptomatic triggered PVCs. A large, prospective randomized study is needed.

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“…18 A report of two patients responding to adenosine has been published. 19 Dilantin was successful in one patient. 20 Cardiac pacing succeeded in two patients.…”

Section: Discussionmentioning

confidence: 94%

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Murray¹

2016

Int J Angiol

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“…The fundamental solution to this problem is to separate VPs from nodal QRS, but how? As a previous paper reported, the coupling interval of VP is affected by various factors, such as sinus rhythm [10], position [11], and drugs [12]. In this case, we tried various methods, such as an intravenous injection of isoproterenol and atrial pacing.…”

Section: Results and Conclusionmentioning

confidence: 99%

Ablation of unmappable ventricular parasystole originating from the right ventricular outflow tract: a case report

Wang

2019

BMC Cardiovasc Disord

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BackgroundWhen the coupling interval is matched, ventricular parasystole can form a stable fusion QRS complex with sinus rhythm. Ablation of a fusion QRS complex has been rarely reported and is unexpectedly difficult.Case presentationWe describe a case of ventricular parasystole from muscle sleeves of the right ventricular outflow tract. The patient was a 54-year-old woman who was admitted to the hospital because of frequent palpitations for 3 months. Anti-arrhythmic drugs had been ineffective, and she had no history of cardiovascular disease. Because the fusion QRS complex interfered with the conventional mapping technique, we could not eliminate the ventricular parasystole successfully.Results and conclusionsFinally, we used the reversed U curve method and found that the source of ventricular arrhythmia was in the right cusp according to the special local potential. A fusion QRS complex formed by ventricular parasystole and nodal ventricular activation make mapping and ablation difficult. The special local potential was the only evidence available to confirm the target of ablation satisfactorily.

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“…Rarely does ventricular fibrillation or syncope occur, and VT is slower than reentrant VT. Several drugs have been tried as treatment for VP. Verapamil produced a satisfactory response in 18% of treated patients A report of two patients responding to adenosine has been published Dilantin was successful in one patient Cardiac pacing succeeded in two patients [48][49][50][51]. Amiodarone produced good results in nine patients only 33% of patients with VP responded to the usual sodium channel blockers [52].…”

Section: Discussion-(2) Pvcsmentioning

confidence: 99%

Re-print: Ranolazine may be the Best and Safest Pharmacologic Therapy for Congestive Heart Failure, and Safe, Effective for Ventricular and Atrial Arrhythmias

Murray¹

2020

JCCI

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Background: Ranolazine (RAN) reduces cardiac sodium channel 1.5’s late sodium current(INaL ) in congestive heart failure (CHF), reducing myocardial calcium overload, potentially improving left ventricular ejection fraction(LVEF) and reducing arrhyth- mogenic after potentials. RAN blocks neuronal sodium channel 1.7(Nav 1.7), potentially altering parasympathetic and sympathetic (P&S) activity. RAN also selectively blocks inactivated atrial Nav 1.8, as well as ventricular IKr and ICaL, affecting atrial and ventric- ular arrhythmias. Methods: (1)Matched CHF patients were given RAN (1000 mg p.o. b.i.d.) added to guideline-driven therapy (RANCHF, 41 systolic, 13 diastolic) or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic). Echocardiographic LVEF and P&S measures were obtained at baseline and follow-up (mean 23.7 months). (2)A total of 59 patients with symptomatic PVCs were identified from full-disclosure Holters. Doses of 500 - 1,000 mg RAN b.i.d. were given to 34% and 66% of patients, respectively, and Holters were repeated (mean 3.1 months). Congestive heart failure (CHF) was defined as symptoms including dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and edema, with a brain natriuretic peptide > 400. Systolic heart failure with reduced ejection fraction (HFr EF) vs. diastolic CHF (HFpEF) depended upon LVEF≥ 40%. Results: (1)LVEF increased in 70% of RANCHF patients, an average of 11.3 units. Mean LVEF remained unchanged in NORANCHF pa- tients. P&S measures indicated cardiovascular autonomic neuropathy (P<0.10 bpm2) in 20% of NORANCHF patients at baseline and 29% at follow-up (increasing in both groups). At baseline, 28% of patients had high sympathovagal balance (SB), RAN normalized SB in over 50% of these; in contrast, the NORANCHF group had a 20% increase in patients with high SB. (2)Upon repeat Holters at a mean of 3.1 months after initiating RAN, 95% (56/59) of the patients had their PVC count reduced: 24% (14/59) had more than 90% decrease, 34% (20/59) had 71 to 90% decrease, and 17% (10/59) had 50 to 70% decrease. In the entire group, RAN reduced PVCs by 71% (mean 13,329 to 3,837; p < 0.001). Ventricular bigeminy was reduced by 80% (4,168 to 851; p < 0.001), ventricular couplets were reduced by 78% (374 to 81; p < 0.001), and ventricular tachycardia (VT) was reduced by 91% (56 to 5; p < 0.001). The PVC reduction was dose dependent without proarrhythmia. Conclusions: (1)RAN preserves or improves LVEF and decreases high SB in CHF. (2)RAN offers an effective and safe pharmacologic treatment for symptomatic PVCs.

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Effect of adenosine on ventricular parasystole

Cited by 5 publications

References 7 publications

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Ablation of unmappable ventricular parasystole originating from the right ventricular outflow tract: a case report

Re-print: Ranolazine may be the Best and Safest Pharmacologic Therapy for Congestive Heart Failure, and Safe, Effective for Ventricular and Atrial Arrhythmias

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