Intravenous diltiazem for the treatment of supraventricular tachycardia

Abstract

Summary:To determine the effects of diltiazem hydrochloride on patients with paroxysmal supraventricular tachycardia, we administered intravenous diltiazem, 0.25 mg/kg to patients who presented to the Stanford Medical Center Emergency Department with this rhythm. Blood pressure was recorded prior to administration, and monitored for 20 min thereafter. Six of the ten patients converted to sinus rhythm a mean of 7.75 min (k4.4) after drug administration. The remaining four experienced slowing of heart rates from a mean of 177 to 166 beatdmin. Systolic blood pressure fell a mean of 12.4 mmHg during treatment, but returned to pretreatment level or higher within 20 min following diltiazem administration. This mean degree of blood pressure reduction compares favorably with effects produced by intravenous verapamil under comparable circumstances. Intravenous diltiazem appears to be a safe and effective dmg for the conversion of paroxysmal supraventricular tachycardia.

Intravenous Diltiazem for Treatment of Supraventricular Tachycardia after Coronary Artery Bypass Surgery

“…Although there was no difference between the three groups after the first dose, there were differences after the second dose at 10 and 15 minutes; at 10 minutes after the second dose, group 1 had a significantly higher mean cardiac index than groups 2 and 3; at 15 minutes after the second Optimum bolus doses of diltiazem are reported to be 0.25 mg·kg -1 and 0.35 mg·kg -1 infused intravenously over 2 minutes. 1,2,6,7 In our study, a positive response was seen in 29% of patients with the 0.25 mg·kg -1 dose. An additional 32% of the patients had a positive response to the second dose of 0.35 mg·kg -1 giving an overall response rate of 61%.…”

“…Other studies examining only sustained supraventricular arrhythmia reported an incidence in the range of 11.4% to 40.1%. [3][4][5][6][7][8][9] The occurrence of atrial fibrillation has been correlated with abnormal phase IV depolarization, conduction velocity, and transmembrane action potential in patients aged 40 years and older. [3][4][5][6] Atrial infarction, left atrial hypertension, local surgical trauma (cannulation of atria), pericarditis, and age-dependent atrial atrophic changes may be contributing factors to postoperative atrial fibrillation.…”

“…[3][4][5][6] Atrial infarction, left atrial hypertension, local surgical trauma (cannulation of atria), pericarditis, and age-dependent atrial atrophic changes may be contributing factors to postoperative atrial fibrillation. [7][8][9][10][11][12][13][14] The toleration of atrial fibrillation depends on the ventricular rate, the degree of underlying left ventricular systolic and diastolic dysfunction, and the duration of the arrhythmia. The loss of atrial systole when combined with tachycardia and a reduced filling time as well as increased myocardial oxygen consumption, may have deleterious effects.…”

“…[1][2][3][4][5][6][7] Currently, oral diltiazem is recommended for the treatment of atrial arrhythmias. 8,9 Intravenous diltiazem was found in several studies to be useful for the conversion of supraventricular tachycardia to sinus rhythm and control of ventricular rhythm in atrial fibrillation.…”

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.…”