Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias.

Rinkenberger, Robert L.; Prystowsky, Eric N.; Heger, James J.; Troup, Paul J.; Jackman, Warren M.; Zipes, Douglas P.

doi:10.1161/01.cir.62.5.996

Cited by 245 publications

(33 citation statements)

References 47 publications

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“…191 The precise location of the focal AT is ultimately confirmed by mapping during EP studies when successful ablation is achieved. [123][124][125][126][127][192][193][194][195][196] Focal AT has been localized to the crista terminalis, right or left atrial free wall or appendage, tricuspid or mitral annulus, paraseptal or paranodal areas, pulmonary veins, coronary sinus, and coronary cusps, but it originates more frequently from the right atrium than from the left atrium. 197,198 The underlying mechanism of focal AT can be automatic, triggered activity, or microreentry, but methods to distinguish the mechanism through pharmacological testing or EP study are of modest value because of limited sensitivity and specificity.…”

Section: Focal Atrial Tachycardiamentioning

confidence: 99%

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Page¹,

Joglar²,

Caldwell³

et al. 2016

Circulation

337

127

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Section: Focal Atrial Tachycardiamentioning

confidence: 99%

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Page¹,

Joglar²,

Caldwell³

et al. 2016

Circulation

337

127

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“…26 27 We have frequently observed complex cycle length oscillations before termination of nonsustained ventricular tachycardia recorded during ambulatory monitoring (unpublished observations). We suspect that cycle length oscillations may contribute to termination in many experimental and clinical tachycardias caused by reentry.…”

Section: Discussionmentioning

confidence: 96%

Oscillations of conduction, action potential duration, and refractoriness. A mechanism for spontaneous termination of reentrant tachycardias.

1988

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The mechanism of cycle length oscillation and its role in spontaneous termination of reentry was studied in an in vitro preparation of canine atrial tissue surrounding the tricuspid orifice. Reentry occurred around a fixed path with incomplete recovery of excitability. Among 18 experiments, there was complete concordance between the occurrence of spontaneous cycle length oscillation and spontaneous terminations; both were observed in 10 experiments and neither in the other eight (p<0.001). Local changes in conduction during oscillations resulted from the dependence of both conduction velocity and action potential duration on the preceding local diastolic interval. Interval-dependent changes in action potential duration contributed to the oscillation by altering the next diastolic interval. Because of changes in action potential duration, changes in cycle length were poorly correlated with changes in diastolic interval and, therefore, with local conduction velocity. Complex oscillations resulted from variations in conduction time at multiple sites in the circuit. Oscillations caused most spontaneous terminations. The critical event was an exceptionally long diastolic interval preceding the next-to-last cycle that accelerated local conduction (which tended to shorten the last cycle) and prolonged action potential duration and refractoriness at the site of block. Ninety-two of 99 recordings of spontaneous termination showed evidence of oscillation of conduction and refractoriness causing block. (Circulation 1988;78:1277-1287

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“…Oral verapamil has been used successfully (in combination with pindolol) for terminating re-entrant supraventricular tachycardias [8] but to our knowledge there are no reports of oral verapamil being used alone for the acute management of such arrhythmias. However, oral verapamil is widely used for the prophylaxis of some paroxysmal supraventricular arrhythmias [9] although its efficacy has recently been questioned [10]. Administered sublingually or buccally to healthy volunteers, verapamil has been previously shown to have characteristics intermediate between those seen following intravenous-bolus and oral administration [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Preliminary investigation of the efficacy of sublingual verapamil in the management of acute atrial fibrillation and flutter.

Fort

Lewis

et al. 1994

Brit J Clinical Pharma

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The antiarrhythmic properties of sublingual verapamil were investigated in seven patients with acute fast atrial flutter (n = 2) or fibrillation (n = 5). A rapid and significant (P < 0.05) reduction in the ventricular rate was achieved in all seven patients. The ventricular rate at peak plasma verapamil concentration (± s.d.) was significantly slower than on admission (101.6 ± 11.3 and 159 ± 5.3 beats min-I respectively, P < 0.01). The ventricular rate remained controlled for over 4 h. Sublingual verapamil was rapidly absorbed with the maximum peak plasma concentration (153.3 ± 15.5 ng ml-') being achieved after 1.21 ± 0.18 h. Side-effects of sublingual verapamil were limited to one report of a bitter taste. The sublingual administration of verapamil may provide an alternative method for the control of acute fast atrial fibrillation and flutter in selected patients.

show abstract

Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias.

Cited by 245 publications

References 47 publications

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Oscillations of conduction, action potential duration, and refractoriness. A mechanism for spontaneous termination of reentrant tachycardias.

Preliminary investigation of the efficacy of sublingual verapamil in the management of acute atrial fibrillation and flutter.

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