Parenteral Tiapamil Treatment of Arrhythmias in Cardiac Patients

Abstract

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.

Class IV Antiarrhythmic Agents: New Compounds Using an Old Strategy

“…Hypotension and bradycardia were observed in 5 out of 20 patients [273]. Similar results were reported in another article but tiapamil was effective both against supraventricular premature complexes and VPCs in contrast to other CCAs [274]. In AMI patients, tiapamil effectively reduced the number of premature ventricular contractions [275], supraventricular extra beats [276] and HR to less than 90 beats/min, which latter effect was also seen in reoccurring tachyarrhythmias during successive tiapamil administrations [277].…”

Tiapamil, a new calcium antagonist: hemodynamic effects in patients with acute myocardial infarction.

“…or leaving it unchanged.4 Tiapamil did not, however, depress myocardial contractility in patients with coronary artery disease.4 Several investigators have reported that tiapamil has a beneficial effect in those with supraventricular arrhythmias and also in those with ventricular premature contractions. [14][15][16] Tiapamil might thus be a suitable agent for reducing size of myocardial infarction. In this double-blind.…”