Suppression of Ventricular Arrhythmias by Transvenous Intracardiac Pacing

Heiman, Donald F.

doi:10.1001/jama.1966.03100130124040

Cited by 90 publications

(6 citation statements)

References 3 publications

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“…Though the action of isoprenaline in increasing cardiac output and coronary blood flow may also play a part, we believe that it is the increase in heart rate that is most important in suppressing the abnormal ventricular activity. Analogous to this is the use of artificial cardiac pacing at rapid ventricular rates to suppress persistent ventricular arrhythmias, as described by Sowton, Leatham, and Carson (1964), Heiman and Helwig (1966), and Lew and March (1967). The effectiveness of the beta-adrenergic blocking agent propranolol in terminating ventricular arrhythmias has been reported (Sloman, Robinson, and McLean, 1965).…”

Section: Discussionmentioning

confidence: 99%

Use of isoprenaline as an antiarrhythmic agent after valve replacement surgery.

Gunning¹,

Shanahan²,

Windsor³

1969

Heart

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The sympathomimetic drugs are generally considered to increase cardiac automaticity, thus predisposing to ventricular ectopic beats, ventricular tachycardia, and ventricular fibrillation (Foster, 1966;Hellerstein, Brofman, and Caskey, 1952). This paper describes the use of isoprenaline, a sympathomimetic drug, as an antiarrhythmic agent in three patients. These patients were having recurrent ventricular tachycardia and ventricular fibrillation in the early post-operative period after cardiac valve replacement. CASE REPORTS Case 1. A married woman, aged 53 years, had become increasingly breathless over 10 years. This was accompanied by lethargy and recurrent bronchitis and orthopnoea. The clinical signs of mitral stenosis, aortic stenosis and incompetence, and tricuspid incompetence were present. Chest x-ray showed biventricular and left atrial enlargement, increased pulmonary vascular markings, and septal lymphatic lines. Electrocardiogram showed atrial fibrillation and left ventricular hypertrophy. Cardiac catheterization and cine-angiography confirmed the clinical diagnosis. Both the mitral and aortic valves were calcified.Aortic replacement with a No. 8 Starr-Edwards prosthesis, mitral commissurotomy, and tricuspid valve annuloplasty were performed. Two hours after operation carried out on January 26, 1967, the electrocardiogram showed atrial fibrillation with ventricular bigeminy (Fig. A). Serum potassium was 2-0 mEq/litre, and 50 mEq potassium were given by infusion in the following 3 hours. After this ventricular bigeminy ceased. Serum potassium 5 hours after operation was 3-3 mEq/ litre. Four hours later ventricular bigeminy again developed and was followed by short episodes of ventricular tachycardia and fibrillation which reverted spontaneously (Fig. B). Procainamide 500 mg. intravenously, and 40 mEq/litre potassium by intravenous infusion were given. An hour later ventricular fibrilla-83 tion occurred and in the subsequent 90 minutes, 50 defibrillations were performed. Procainamide 500 mg. was repeated and lignocaine 40 mg. was given at 10-minute intervals for 5 doses without effect. Between episodes of ventricular fibrillation, the cerebral state was lucid and the systemic blood pressure was 115/70 mm. Hg. An hour later an isoprenaline infusion, 1 mg. in 500 ml. 5% dextrose in water, was begun. Almost immediately the episodes of ventricular arrhythmia ceased. Blood pressure remained at 120/80 mm. Hg. Two hours later episodes of ventricular tachycardia recurred followed by ventricular fibrillation requiring electric countershock When the rate of the isoprenaline infusion was increased, the arrhythmias ceased (Fig. C). Between 17 hours and 21 hours after the operation 100 defibrillations were necessary. During this period, isoprenaline infusion, 2 mg. in 500 ml., was continued. Other treatment included an infusion of lignocaine 300 mg., digoxin 0 5 mg. intravenously, procainamide 500 mg. intramuscularly six-hourly, and potassium 10 mEq/litre/hour intravenously. Subsequent serum potassium estimations were...

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Section: Discussionmentioning

confidence: 99%

Use of isoprenaline as an antiarrhythmic agent after valve replacement surgery.

Gunning¹,

Shanahan²,

Windsor³

1969

Heart

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“…The usefulness of both permanent atrial and ventricular pacing in the prevention of tachyarrhythmias has been well documented .2, 5~ [11][12][13][14][15][16][17][18][19] Their use also has been well outlined in the treatment of bradyarrhythmias including SA and AV block. 1, 9, 2~~ 2 2, 23~ 34 It therefore seems logical to treat the syndrome of episodic bradycardia and tachycardia with permanent pacing.…”

Section: Transvenous Pacemarkermentioning

confidence: 99%

Treatment of the Bradycardia-Tachycardia Syndrome with Permanent Demand Pacing

Pittman

1976

Angiology

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The bradycardia-tachycardia syndrome (paroxysmal supraventricular tachycardia alternating with sinus bradycardia and episodes of sinus node arrest) has previously presented a complicated therapeutic dilemma when excitatory and suppressive drugs have been utilized. A patient with this syndrome successfully treated with a permanent ventricular transvenous demand pacemaker is presented. Various aspects of this syndrome as well as facets of diagnosis and treatment have been reviewed and discussed. Significant underlying cardiac disease was ruled out in this patient by the usual diagnostic methods including left heart catheterization and coronary angiography. An interesting possibility of the relationship of vagal stimulation secondary to hiatus hernia as an etiologic factor in this syndrome has been discussed. The opinion is expressed that the currently preferred method of treatment is the insertion of a permanent transvenous pacemaker alone or in conjunction with antiarrhythmic drugs, preferably digitalis and propranolol.

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“…Electrical pacing.-The use of electrical pacemakers via cardiac catheters stimulating the endocardium of the right side of the heart is an established method of treatment of bradyarrhythmias, including heart block, in acute myocardial infarction, More recently, however, electrical pacing has been used successfully in the management of atrial and ventricular tachyarrhyth mias (63)(64)(65)(66). The suppression of rapid ectopic rhythms may be due to several mechanisms: (a) competition of the pacemaker with the ectopic focus; (b) "overdrive suppression," a term applied to the phenomenon of inhibition of pacemaker activity by rapid electric stimulation; (c) the interruption of re entry, rendering refractory areas of the myocardium involved in the cir cuitous pathways (66)(67)(68).…”

Section: S£lzer and Co Hnmentioning

confidence: 99%

Treatment of Ventricular Extrasystoles and Tachyarrhythmias in Acute Myocardial Infarction

Selzer¹,

Cohn²

1970

Annu. Rev. Med.

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Two developments at the beginning of this decade exerted a profound influence upon clinical management of acute myocardial infarction: the in troduction of closed-chest resuscitation with electric shock therapy for ven tricular fibrillation, and the availability of continuous monitoring of the electrocardiogram by means of the cathode-ray oscilloscope. As a result of this, the coronary care unit has become a standard facility for the treatment of myocardial infarction. I t should be recognized that the concept of thera peutic centers for patients with myocardial infarction encompasses a broad range of facilities available in such units (1). On the one end of the spectrum, one can place the comprehensive cardiology center, equipped to treat all as pects and complications of myocardial infarction, including the use of emer gency surgery and artificial pump-support. On the other end, is the small area in a hospital in which nurses can observe the patient's rhythm displayed upon the monitoring oscilloscope. The great majority of coronary care units ap proach the latter end of the spectrum-based primarily on the availability of electrocardiographic monitoring units. Thus, the role of such units is the identification, early recognition, treatment, and prevention of dangerous arrhythmias. The most common arrhythmias that are potentially life-threat ening are related to increased "irritability" of the ventricular myocardium. The purpose of this review is to examine the rationale for the therapy of ventricular arrhythmias in acute myocardial infarction-both the fundamen tal and practical considerations. INCIDENCE OF ARRHYTHMIASDuring the earlier era, when the diagnosis of arrhythmias was based on their occurrence during routine examination of the patient or during record ing of an electrocardiographic tracing, the incidence of arrhythmias was es timated to range between 9 and 27 percent, with an average of 18 percent

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Suppression of Ventricular Arrhythmias by Transvenous Intracardiac Pacing

Cited by 90 publications

References 3 publications

Use of isoprenaline as an antiarrhythmic agent after valve replacement surgery.

Use of isoprenaline as an antiarrhythmic agent after valve replacement surgery.

Treatment of the Bradycardia-Tachycardia Syndrome with Permanent Demand Pacing

Treatment of Ventricular Extrasystoles and Tachyarrhythmias in Acute Myocardial Infarction

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