Beneficial effect of intravenous diltiazem in the acute management of paroxysmal supraventricular tachyarrhythmias.

Abstract

We tested the effectiveness and safety of i.v. diltiazem in the management of paroxysmal supraventricular tachyarrhythmias in 39 patients, 21 with organic heart disease and seven in heart failure. Fifteen patients presented with supraventricular tachycardia, 12 with atrial fibrillation and 12 with atrial flutter. End points were conversion to sinus rhythm or slowing of the ventricular rate to 100 beats/min or less. Diltiazem was given as an i.v. bolus of either 150 or 300 micrograms/kg over 2 minutes. A second injection was administered to patients who received the lower dose and failed to reach either end point within 30 minutes. The overall success rate was 82% (32 of 39 patients). Time to end point was 5 minutes or less in 20 patients. Conversion to sinus rhythm occurred in 13 of 15 patients (87%) with supraventricular tachycardia and in two of 12 patients with atrial fibrillation. Treatment side effects included a slow ventricular rate in one patient who had a sick sinus syndrome and hypotension in two patients that rapidly responded to fluid administration. We conclude that i.v. diltiazem is effective and well tolerated and advocate its use in the management of paroxysmal supraventricular tachyarrhythmias.

Intravenous diltiazem for the treatment of supraventricular tachycardia

“…The occurrence of premature ventricular contractions which we observed has been known to occur at the time of conversion by intravenous diltiazem as well as by verapamil (Betriu et al, 1983;Krikler, 1974;Singh et al, 1980). Unlike subjects in other studies, our patients had no known organic heart disease, and the supraventricular tachyarrhythmias were of spontaneous origin, not induced.…”

“…Betriu noted a beneficial effect of diltiazem in patients with supraventricular tachyarrhythmias (Betriu et al, 1983). Administration of intravenous diltiazem, 150-300 pg/kg over 2 min, resulted in conversion to sinus rhythm in 13 of 15 patients (87%) with paroxysmal supraventricular tachycardia.…”

Class IV Antiarrhythmic Agents: New Compounds Using an Old Strategy

“…Slow-release formulation of diltiazem (120 mg twice a day) similarly to D600 (100 mg twice a day) and verapamil (120 mg twice a day) reduced peak HRs recorded during a 6-min walking test to similar extent in 18 permanent AF patients without organic heart disease but receiving oral digoxin [262]. Intravenous diltiazem effectively converted VT to SR (in 87 % of SVT patients) or slowed HR to 100 beats/min or even below (in 82 % of patients) [302]. Similar results were found in patients with inducible sustained SVT but diltiazem had no effect on the electrophysiological properties of accessory AV connections and was safe and very effective for acute tachycardia termination when the AV node was part of the reentrant circuit [303].…”

“…These results suggest that S-2150 is a favorable hypotensive agent for hypertensive patients with ischemic heart disease [312]. Diltiazem / once 120 mg or 3x80 mg daily per os lowered VR in patients with AF [296] Diltiazem / 4x60 mg per os reduced the maximal and submaximal HRs during exercise [297] Diltiazem / bolus of either 150 or 300 µg/kg over 2 minutes intravenously converted VT to SR, reduced HR to 100 beats/min [302] Diltiazem / continuous infusion of for 24 h (minimum dose, 0.l reduced the incidence of AF after coronary bypass grafting [305] mg/kg/h) Diltiazem / 0.2 mg/kg intravenously for 3 minutes terminated programmed electrical stimulation induced SVT at high right atrium [310] Clentiazem (TA-3090) / 0.1 mg/kg intravenously for 3 minutes terminated programmed electrical stimulation induced SVT at high right atrium [310] Clentiazem / 80 and 120 mg/day antianginal action in patients with stable angina [311] Clentiazem / 80 and 120 mg/day induced first-degree AV block as a sideeffect in patients with stable angina [311] 9.3. Other CCAs Semotiadil (SD-3211) Animal studies with semotiadil…”

Postoperative Antiarrhythmic Effects of Diltiazem in Patients Undergoing Coronary Bypass Grafting

“…According to results of various studies, another calcium channel antagonist, diltiazem, combines systemic and coronary vasodi lation [7][8][9] with myocardial protection [10][11][12] and antiarrhythmic effects [13][14][15][16][17], It is well demonstrated that diltiazem has a direct effect on supraventricular tachycardias by its known influence on the atrioventricular conduction [13][14][15][16]18]. Diltiazem given parenterally is in up to 95% of patients successful in breaking the tachycardia and in restoring a regular sinus rhythm [19][20][21], Because it re presents the most frequent form of arrhyth mias in coronary surgery, the suppression of supraventricular tachycardias is of special clinical importance.…”