Misuse of Intravenous Verapamil in Patients With Ventricular Tachycardia

Rankin, A C; Rae, A P; Cobbe, S M

doi:10.1016/s0140-6736(87)91790-9

Cited by 47 publications

(13 citation statements)

References 19 publications

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“…However, no evidence of this type for verapamil or any other calcium antagonist in humans was previously available. Clinical experience with the acute administration of verapamil has suggested the potential for acute hypotensive and negative inotropic sequelae (2,4), a complication that is rarely observed in the absence of tachyarrhythmias.…”

Section: Discussionmentioning

confidence: 99%

“…Onset of tachycardia in patients administered class I (sodiumchannel blocker) or class IV (calcium-channel antagonist) antiarrhythmic drugs is associated with increased risk of acute hemodynamic collapse, despite these agents being well tolerated in sinus rhythm (1,2). Changes in heart rate may thus unmask negative inotropic effects of cardioactive drugs not apparent at rest, which may contribute to increased mortality during treatment with such agents in patients with impaired left ventricular systolic function (3,4).…”

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confidence: 99%

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Attenuation of the Negative Inotropic Effects of Metoprolol at Short Cycle Lengths in Humans

Ritchie

Zeitz²,

Wuttke³

et al. 2006

Journal of the American College of Cardiology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Attenuation of the Negative Inotropic Effects of Metoprolol at Short Cycle Lengths in Humans

Ritchie

Zeitz²,

Wuttke³

et al. 2006

Journal of the American College of Cardiology

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“…Many tachycardias, particularly those with broad complexes, are misdiagnosed.5 This may have serious therapeutic implications, because verapamil has been commonly administered to patients with ventricular tachycardia misdiagnosed as supraventricular with aberration. 7 While the response to verapamil may also be of diagnostic value,24 the high incidence of adverse effects makes its use inadvisable.7"26By contrast, the use ofadenosine in the acute diagnosis and treatment of broad complex tachycardias seems to be safe. Adenosine has been reported to have a similar diagnostic value in regular broad complex tachycardias initiated by programmed stimulation, when the diagnosis of ventricular tachycardia is based solely on the lack ofan effect ofadenosine.6'The present results additionally show that adenosine may allow a positive diagnosis of ventricular tachycardia in those patients with 1:1 retrograde atrial activation, by producing ventriculoatrial dissociation.…”

Section: Clinical Value and Limitations Of Adenosinementioning

confidence: 99%

Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias.

Rankin

Oldroyd

Chong

et al. 1989

Heart

146

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SUMMARY The diagnostic and therapeutic potential of intravenous adenosine was studied in 64 patients during 92 episodes of regular sustained tachycardia. In 40 patients who had narrow complex tachycardias (QRS <0-12 s) adenosine (2-5-25 mg) restored sinus rhythm in 25 with junctional tachycardias (46 of 48 episodes) and produced atrioventricular block to reveal atrial or sinus tachycardia in 15. In 24 patients with broad complex tachycardias (QRS > 0 12 s) adenosine terminated the tachycardias in six patients and revealed atrial or sinus arrhythmias in four. The tachycardias persisted in 14 patients despite doses up to 20 mg, but adenosine allowed the diagnosis of ventricular tachycardia with retrograde atrial activation in two patients by producing transient ventriculoatrial dissociation. Diagnosis based on adenosine induced atrioventricular nodal block was correct in all patients with narrow complex tachycardias and in 92% of those with broad complex tachycardias, compared with correct electrocardiographic diagnoses in 90% and 75% respectively. Adenosine gave diagnostic information additional to the electrocardiogram in 25%. The response to adenosine in broad complex tachycardias identified those of supraventricular origin with 90% sensitivity, 93% specificity, and 92% predictive accuracy. Adenosine restored sinus rhythm in all patients with junctional reentrant tachycardias, but in 10 (35%) the arrhythmias recurred within two minutes. Symptomatic side effects (dyspnoea, chest pain, flushing, headache) were reported by 40 (63%) patients and, although transient, were severe in 23 (36%). There were ventricular pauses ofover 2 s in 16% of patients, the longest pause being 6*1 s.Adenosine is ofvalue in the diagnosis and treatment of narrow and broad complex tachycardias, but its use is limited by symptomatic side effects, a tenfold range in minimal effective dosage, occasional action at sites other than the atrioventricular node, and early recurrence of arrhythmia.Adenosine is a naturally occurring, rapidly metabolised compound that produces transient atrioventricular nodal block in humans when injected intravenously.' It can terminate reentrant supraventricular tachycardias that involve the atrioventricular node,' while in tachycardias of atrial origin it may be of diagnostic value, because adenosine induced atrioventricular block slows the ventricular rate and reveals the unaffected atrial arrhythmia.2 Such diagnostic and therapeutic effects of adenosine should be of most value in broad complex Requests for reprints to Dr A C Rankin,

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“…Vorteile gegenüber anderen Antiar-rhythmika sind die sehr kurze Halbwertszeit mit weniger als 2 Sekunden sowie die geringen Auswirkungen auf den Blutdruck, die eine repetitive Anwendung erlauben. Bei Patienten mit Tachykardien mit verbreitertem QRS-Komplex ist der Einsatz von Adenosin im Gegensatz zum Verapamil erlaubt (38). Eine Terminierung dieser Tachykardieformen nach Adenosinapplikation erlaubt mit großer Sicherheit die Diagnose einer supraventrikulären Tachykardie mit funktionellem Schenkelblock (32).…”

Section: Supraventrikulåre Tachykardien Auf Der Grundlage Akzessoriscunclassified

Supraventrikuläre Tachykardien bei Säuglingen, Kindern und Jugendlichen: Diagnostik – Medikamentöse und interventionelle Therapie

Paul¹,

Bertram²,

Kriebel³

et al. 2000

Z Kardiol

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Supraventricular tachycardias are the most frequent forms of symptomatic tachyarrhythmias in infants, children and adolescents. Clinical symptoms depend on age and underlying cardiac anatomy. Newborn babies and infants with paroxysmal atrioventricular reentrant tachycardias usually present with signs of congestive heart failure due to rapid heart rate. In older children and adolescents, palpitations are the leading symptom. Patients with chronic-permanent tachycardias (i.e., atrial ectopic tachycardia, permanent form of junctional reciprocating tachycardia) often develop a secondary form of dilated cardiomyopathy, the so-called "tachymyopathy". Adenosine has evolved as the drug of choice in any age group for the termination of atrioventricular reentrant tachycardia of any origin. In addition, it serves as a diagnostic tool in primary atrial tachycardias. Long-term management of atrioventricular reentrant tachycardia in infancy and childhood is age dependent. In newborn babies and infants, pharmacological therapy is advised due to the high spontaneous cessation rate of those tachycardias at the end of the first year of life. In contrast to this, the probability of spontaneous cessation of tachycardia in children > 1 year of age is very low. Therefore, radiofrequency catheter ablation of the anatomical substrate of the tachycardia is a rational alternative to long-lasting antiarrhythmic therapy. Results in children with a structurally normal heart are comparable to those achieved in adults. In patients with congenital heart disease and supraventricular tachycardias, catheter ablation during preoperative cardiac catheterization is recommended. Atrial reentrant tachycardias have been identified as one major risk factor for late postoperative morbidity and mortality in young patients. Pharmacological therapy is often not sufficient to control the tachycardia. In addition, underlying sinus node dysfunction may be aggravated in a considerable portion of the patients affected. Catheter ablation based on conventional endocardial mapping techniques by multipolar electrode catheters with the aim of identifying the critical region of the reentrant circuit is associated with an impaired success rate and a considerable recurrence rate. It may be assumed that, using the modern mapping techniques currently available (electroanatomical mapping and non-contact mapping), results of radiofrequency catheter ablation of atrial reentrant tachycardias after surgical correction of congenital heart disease will be significantly improved within the next few years.

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Misuse of Intravenous Verapamil in Patients With Ventricular Tachycardia

Cited by 47 publications

References 19 publications

Attenuation of the Negative Inotropic Effects of Metoprolol at Short Cycle Lengths in Humans

Attenuation of the Negative Inotropic Effects of Metoprolol at Short Cycle Lengths in Humans

Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias.

Supraventrikuläre Tachykardien bei Säuglingen, Kindern und Jugendlichen: Diagnostik – Medikamentöse und interventionelle Therapie

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