Tiapamil in the Management of Supra ventricular Arrhythmias Occurring after Acute Myocardial Infarction

Abstract

18 patients with acute myocardial infarction and sustained supra ventricular arrhythmias were treated with tiapamil, in a dose of 1 mg/kg i.v. The drug was effective, i.e., the heart rate was reduced to less than 90 beats/min in 9 of 10 patients with atrial fibrillation, in 3 of 4 patients with atrial flutter, and in 3 of 4 patients with atrial tachycardia. The peak effect was observed within 2-5 min. In cases with recurring tachyarrhythmias, tiapamil was also effective during successive administrations, the systolic blood pressure was reduced by 10-15%, but severe hypotension was not observed. In these patients, no major changes in atrioventricular or intraventricular conduction were observed. In the dose used, tiapamil was effective and well tolerated.

Class IV Antiarrhythmic Agents: New Compounds Using an Old Strategy

“…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]. 1 mg/kg intravenous tiapamil significantly reduced the number of exercise-induced extrasystoles in patients 3-6 weeks after AMI [278].…”

“…There are no human data about the antiarrhythmic actions of anipamil only the systolic and diastolic BP reducing [285] and anti ischemic effects of the drug were documented [286]. [239] Verapamil / 3 x 120 mg daily for at least 5 half-lives to load reduced VT in approximately 2/3 of the patients in idiopathic VT of left bundle branch block-like morphology [240] Verapamil / 5-20 mg/min intravenously terminated paroxysmal sustained monomorphic VT, repetitive non-sustained VT or premature ventricular contractions [241] Verapamil / 0.2 mg/kg intravenously reduced the number of premature ventricular complexes in catecholaminergic polymorphic VT carrying a cardiac ryanodine receptor mutation [244] Verapamil / 0.25-1.0 mg intracoronary terminated all reperfusion-induced arrhythmias except for VFs and reduced various ischemia-induced arrhythmias [246] Verapamil / up to 20 mg in 1 mg/min increments, intravenously, titrated to effect in supraventricular tachyarrhythmia VR was reduced below 100 beats/min in patients within 72 hours with of AMI, conversion to SR was done in most patients with AFL [218] Verapamil / 240 mg SR tablet daily right ventricular outflow tract tachycardia was terminated [247] D600 / 100 mg per os decreased the HR for 10 hours in AF [259] Tiapamil / 1 mg/kg intravenously reduced VR and rhythm was converted to SR in some cases in AFL, AF or PSVT patients [268] Tiapamil / 1 mg/kg or 50 µg/kg/min for 4 h intravenously ectopic beats were reduced in patients with atrial and ventricular premature beats, AV CT was increased in chronic AF [269] Tiapamil / a bolus of 2 mg/kg intravenously, 1x 1.2-1.5 g daily restored SR and prevented tachycardias in patients with recurrent PSVT having no accessory pathway [270] Tiapamil / 3 x 200 mg daily per os positive effects in supraventricular and ventricular extrasystoles [272] Tiapamil / 1 mg/kg then 50 µg/kg/min for 4 h intravenously reduced ischemia related arrhythmias, decreased the VR in patients with AF [273] Tiapamil / 1 mg/kg then 25 µg/kg/min intravenously reduced the number of premature ventricular contractions, supraventricular extra beats, HR to less than 90 beats/min and exercise-induced extrasystoles in patients with or after AMI [275] [276] [277] [278] Tiapamil / 1-1.5 mg/kg intravenously reduced intra-and postoperative cardiac arrhythmias such as AF, supraventricular paroxysmal tachycardia and in VEBs [279] 9.2. Benzothiazepines Diltiazem Animal studies with diltiazem Antiarrhythmic actions of diltiazem on both ischemia-and reperfusion-induced arrhythmias were described in rats [287], …”