ajmaline and Arrhythmias--Cardiac

Cardiovascular emergencies are rare during pregnancy with an incidence of 0,2-4,0%. Emergencies include arrhythmias, acute coronary syndrome, peripartum cardiomyopathy and hypertensive disorders. Electrical DC-cardioversion with 50-100 Joules is indicated in the acute treatment of arrhythmias in all patients in an unstable hemodynamic state. If 100 J fails higher energies (up to 360 J) will be necessary. In stable supraventricular tachycardia intravenous adenosine is the first choice drug and may safely terminate the arrhythmia. Ventricular premature beats are frequently present during pregnancy and benign in most patients. However, life-threatening ventricular tachyarrhythmias (sustained ventricular tachycardia [VT], ventricular flutter [VFlt], ventricular fibrillation [VF]) were observed less frequently. Electrical DC-cardioversion is necessary in all pregnant women who are in a hemodynamically unstable state and have a life-threatening ventricular tachyarrhythmias. In hemodynamically stable pregnant women the initial therapy with ajmaline, procainamide or lidocaine is indicated. Implantation of a cardioverter-defibrillator is indicated in patients with syncope caused by VT, VF, VFlt or aborted sudden death.

Topics: Adenosine; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Defibrillators, Implantable; Electric Countershock; Female; Humans; Lidocaine; Pregnancy; Pregnancy Complications, Cardiovascular; Procainamide

A number of conventional and newer antiarrhythmic agents are available for the treatment and prophylaxis of ventricular tachycardia and sudden death. Using a multifaceted approach of programmed electrical stimulation studies, drug level determinations, exercise tolerance testing, and 24-hour ambulatory electrocardiographic monitoring, the physician can identify those patients who require therapy and then predict the likelihood of efficacy with each antiarrhythmic agent. This approach affords evaluation of both aspects of the sudden death equation-ectopy frequency (triggering mechanism) and vulnerability to development of sustained ventricular tachycardia (substrate). After institution of therapy, careful follow-up is necessary to document sustained drug efficacy and detect side effects. Serious adverse reactions necessitate a change in antiarrhythmic therapy, as opposed to lowering drug dosage to an ineffective level. The unacceptably high incidence of sudden death due to electrical instability can be reversed only by a rigorous and dedicated long-term approach to the management of serious ventricular arrhythmias.

Topics: Adrenergic beta-Antagonists; Ajmaline; Amiodarone; Anilides; Anti-Arrhythmia Agents; Aprindine; Arrhythmias, Cardiac; Benzeneacetamides; Bepridil; Bethanidine; Bretylium Tosylate; Disopyramide; Drug Administration Schedule; Encainide; Flecainide; Heart Conduction System; Humans; Imidazoles; Lidocaine; Mexiletine; Moricizine; Myocardial Contraction; Phenothiazines; Phenytoin; Piperidines; Procainamide; Propafenone; Propiophenones; Pyrrolidines; Quinidine; Tocainide; Verapamil

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Dogs; Heart Conduction System; Humans

Topics: Action Potentials; Ajmaline; Amiodarone; Anilides; Animals; Anti-Arrhythmia Agents; Aprindine; Arrhythmias, Cardiac; Benzeneacetamides; Bretylium Tosylate; Disopyramide; Encainide; Hemodynamics; Humans; Kinetics; Moricizine; Morpholines; Phenothiazines; Piperidines; Verapamil

Topics: Adolescent; Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atropine; Cardiac Pacing, Artificial; Child; Electrocardiography; Exercise Test; Heart Conduction System; Humans; Middle Aged; Propafenone; Propiophenones; Sick Sinus Syndrome; Stimulation, Chemical; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Child; Female; Humans; Male; Middle Aged

Wise utilization of antiarrhythmic drugs depends on a profound knowledge of their intracellular effects; however, due to widely varying individual response to such drugs, long clinical experience and a certain degree of empiricism are usually necessary. In view of the negatively inotropic effect of the majority of the antiarrhythmic drugs and the potential danger of their association, it seems advisable to recommend that benign arrhythmias should not be treated. Finally, a thorough understanding of the mechanism of complex arrhythmias is essential in selecting the appropriate medical treatment.

Topics: Action Potentials; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Coronary Disease; Digitalis Glycosides; Dose-Response Relationship, Drug; Heart Conduction System; Humans; Kidney; Mexiletine; Myocardial Contraction; Propranolol; Ventricular Fibrillation; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Action Potentials; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Complexes, Premature; Heart; Heart Conduction System; Humans; Lidocaine; Phenytoin; Practolol; Procainamide; Quinidine; Sparteine; Ventricular Fibrillation; Verapamil

Topics: Adult; Aged; Ajmaline; Animals; Arrhythmias, Cardiac; Atropine; Bretylium Compounds; Cardiac Complexes, Premature; Coronary Care Units; Dogs; Electrocardiography; Female; Heart Block; Humans; Isoproterenol; Lidocaine; Male; Myocardial Infarction; Pacemaker, Artificial; Phenytoin; Procainamide; Quinidine; Tachycardia; Ventricular Fibrillation

Topics: Ajmaline; Arrhythmias, Cardiac; Ataxia; Electric Countershock; Gastrointestinal Diseases; Humans; Lidocaine; Long-Term Care; Phenytoin; Practolol; Procainamide; Propranolol; Psychotherapy; Quinidine; Time Factors

Topics: Administration, Oral; Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Biotransformation; Cardiac Complexes, Premature; Drug Hypersensitivity; Heart; Heart Conduction System; Humans; Hypotension; Injections, Intramuscular; Injections, Intravenous; Tachycardia, Paroxysmal

Topics: Administration, Oral; Adrenergic beta-Antagonists; Adult; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bretylium Compounds; Female; Humans; Injections; Lidocaine; Male; Middle Aged; Myocardial Infarction; Procainamide; Quinidine

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Digitalis Glycosides; Electric Countershock; Electrocardiography; Humans; Pacemaker, Artificial; Propranolol; Quinidine; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Drug Therapy; Humans; Hypnotics and Sedatives; Rauwolfia

Topics: Adolescent; Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Clinical Trials as Topic; Electrocardiography; Female; Humans; Male; Middle Aged; Prajmaline; Tachycardia, Paroxysmal

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Clinical Trials as Topic; Humans; Middle Aged; Prajmaline

A randomized double-blind cross-over trial was carried out in 20 patients suffering from ventricular ectopic contractions (VECs), in order to evaluate the effectiveness of a new antiarrhythmic drug, Propafenone (P), versus Lorajmine (L). The patients were given 900 mg/day P and 600 mg/day L in three divided doses for 3 days. Every patient was evaluated with four 24-hour ambulatory ECGs, the first at the beginning of the trial, the second after the administration of the first drug, the third after the administration of the second drug and the last after wash-out. With P, the average fall in VECs was 70.6 +/- 10.8% with a clinically significant individual response in 14 of the 20 patients (VECs reduction greater than or equal to 75%, VECs mean decrease: 93.5 +/- 2.1%). With L, VECs decreased by 37.4 +/- 14.2% whilst VECs reduction was larger than 75% only in 50% patients (VECs mean decrease 85.8 +/- 3.1%). Lastly, after therapy interruption, VECs globally increased by +5.4 +/- 14.4%. Propafenone is a considerably active drug against ventricular arrhythmias. It proved to be more effective than Lorajmine under our experimental conditions.

Topics: Adolescent; Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Propafenone; Propiophenones

The antiarrhythmic efficacy of tocainide, a new antiarrhythmic substance, has been compared with that of prajmalium bitartrate, a drug in clinical use for many years in the German speaking countries. The investigation was performed as a double-blind cross-over study in 20 patients with ventricular arrhythmias (VA) of various origin. The efficacy was assessed by serial Holter monitoring. Plasma levels were measured to study the dose-effect relationship. Applying to the criterion of a reduction of VA of more than 75% or an improvement according to the Lown grading 8 pts. under tocainide and 7 under prajmalium bitartrate were responders. Side effects were few and under tocainide only 2 pts. had to discontinue the therapy. From the present findings tocainide and prajmalium bitartrate have the same efficient antiarrhythmic effects in the majority of patients.

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Clinical Trials as Topic; Double-Blind Method; Electrocardiography; Female; Heart Diseases; Humans; Lidocaine; Male; Middle Aged; Prajmaline; Tocainide

24-h ECG recordings were used to assess the efficacy of prajmalium bitartrate (PB) in reducing the incidence and the severity of premature ventricular complexes (PVCs), and to compare its antiarrhythmic action with that of Disopyramide. 13 patients with frequent PVCs were distributed randomly into 2 groups. The first group of 7 patients received PB 80 mg/day for 4 days as their first treatment, and disopyramide 400 mg/day for a further 4 days as the second therapy. The succession of the drugs was reversed in the other group of 6 patients. Analysis of the Holter recordings showed that PB and disopyramide reduced PVC frequency to a similar extent as compared to the corresponding wash-out period, viz. by 56.7% (p less than 0.05) and 62.1% (p less than 0.01), respectively. Thus, PB appears to be an effective antiarrhythmic drug and comparable to disopyramide. It may be used to prevent premature ventricular complexes and runs of ventricular tachycardia.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Disopyramide; Drug Evaluation; Electrocardiography; Female; Humans; Male; Middle Aged; Prajmaline; Pyridines

The electrophysiological effects of chloro-acetyl-ajmaline in the Wolff-Parkinson-White syndrome have been studied in 7 patients after an intravenous dose of 1.5 mg/kg of the drug. Preexcitation was abolished in 3 cases, while 3 other subjects showed a slight increase in effective refractory period of the abnormal route of excitation (a mean of 13 ms). The possibility of bringing about a reciprocal rhythm was removed in one case out of two. During tachycardia, chloro-acetyl-ajmaline produced significant lengthening of the ventriculo-atrial conduction time (p less than 0.05). These results show the usefulness of chloro-acetyl-ajmaline in the control of the arrhythmias associated with the Wolff-Parkinson-White syndrome.

Topics: Adolescent; Adult; Ajmaline; Arrhythmias, Cardiac; Clinical Trials as Topic; Drug Evaluation; Electrocardiography; Female; Heart Conduction System; Humans; Male; Middle Aged; Wolff-Parkinson-White Syndrome

Topics: Aged; Ajmaline; Aprindine; Arrhythmias, Cardiac; Clinical Trials as Topic; Electrocardiography; Female; Heart Ventricles; Hemodynamics; Humans; Indenes; Male; Mexiletine; Middle Aged; Propylamines; Time Factors

Topics: Acute Disease; Adult; Aged; Ajmaline; Aminocaproates; Arrhythmias, Cardiac; Clinical Trials as Topic; Female; Heart; Heart Block; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Rupture; Shock, Cardiogenic

Topics: Ajmaline; Arrhythmias, Cardiac; Clinical Trials as Topic; Drug Evaluation; Heart Atria; Heart Ventricles; Humans

Topics: Ajmaline; Arrhythmias, Cardiac; Clinical Trials as Topic; Drug Evaluation; Heart Rate; Humans; Sinoatrial Node

Drug-induced type I Brugada syndrome (BrS) is associated with a ventricular arrhythmia (VA) rate of 1 case per 100 person-years. This study aims to evaluate changes in electrocardiographic (ECG) parameters such as microvolt T wave alternans (mTWA) and heart rate variability (HRV) at baseline and during ajmaline testing for BrS diagnosis.. Consecutive patients diagnosed with BrS during ajmaline testing with 5-year follow-up were included in this study. For comparison, a negative ajmaline control group and an isoproterenol control group were also included. ECG recordings during ajmaline or isoproterenol test were divided in two timeframes from which ECG parameters were calculated: a 5-min baseline timeframe and a 5-min drug timeframe.. A total of 308 patients with BrS were included, 22 (0.7%) of which suffered VAs during follow-up. One hundred patients were included in both isoproterenol and negative ajmaline control groups. At baseline, there was no difference in ECG parameters between control groups and patients with BrS, nor between BrS with and without VAs. During ajmaline testing, BrS with VAs presented longer QRS duration [159 ± 34 ms versus 138 (122-155) ms, p = 0.006], higher maximum mTWA [33.8 (14.0-114) µV versus 8.00 (3.67-28.2) µV, p = 0.001], and lower power in low frequency band [25.6 (5.8-53.8) ms. Ajmaline induced important HRV changes similar to those observed during isoproterenol. Increased mTWA was observed only in patients with BrS. BrS with VAs during follow-up presented worse changes during ajmaline test, including lower LF power and higher maximum mTWA which were independent predictors of events.

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Heart Rate; Humans; Isoproterenol; Prognosis

Ajmaline challenge can unmask subcutaneous implantable cardioverter-defibrillator (S-ICD) screening failure in patients with Brugada syndrome (BrS) and non-diagnostic baseline electrocardiogram (ECG). The efficacy of the SMART Pass (SP) filter, a high-pass filter designed to reduce cardiac oversensing (while maintaining an appropriate sensing margin), has not yet been assessed in patients with BrS. The aim of this prospective multicentre study was to investigate the effect of the SP filter on dynamic Brugada ECG changes evoked by ajmaline and to assess its value in reducing S-ICD screening failure in patients with drug-induced Brugada ECGs.. The S-ICD screening with conventional automated screening tool (AST) was performed during ajmaline challenge in subjects with suspected BrS. The S-ICD recordings were obtained before, during and after ajmaline administration and evaluated by the means of a simulation model that emulates the AST behaviour with and without SP filter. A patient was considered suitable for S-ICD if at least one sensing vector was acceptable in all tested postures. A sensing vector was considered acceptable in the presence of QRS amplitude >0.5 mV, QRS/T-wave ratio >3.5, and sense vector score >100. Of the 126 subjects (mean age: 42 ± 14 years, males: 61%, sensing vectors: 6786), 46 (36%) presented with an ajmaline-induced Brugada type 1 ECG. Up to 30% of subjects and 40% of vectors failed the screening during the appearance of Brugada type 1 ECG evoked by ajmaline. The S-ICD screening failure rate was not significantly reduced in patients with Brugada ECGs when SP filter was enabled (30% vs. 24%). Similarly, there was only a trend in reduction of vector-failure rate attributable to the SP filter (from 40% to 36%). The most frequent reason for screening failure was low QRS amplitude or low QRS/T-wave ratio. None of these patients was implanted with an S-ICD.. Patients who pass the sensing screening during ajmaline can be considered good candidates for S-ICD implantation, while those who fail might be susceptible to sensing issues. Although there was a trend towards reduction of vector sensing failure rate when SP filter was enabled, the reduction in S-ICD screening failure in patients with Brugada ECGs did not reach statistical significance.. https://clinicaltrials.gov Unique Identifier NCT04504591.

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Defibrillators, Implantable; Electrocardiography; Humans; Male; Middle Aged; Prospective Studies

The Brugada pattern manifests as a spontaneous variability of the electrocardiographic marker, suggesting a variability of the underlying electrical substrate.. The purpose of this study was to investigate the response of the epicardial substrate of Brugada syndrome (BrS) to programmed ventricular stimulation and to Na blocker infusion.. We investigated 6 patients (all male; mean age 54 ± 14 years) with BrS and recurrent ventricular fibrillation. Five had no type 1 BrS electrocardiogram pattern at admission. They underwent combined epicardial-endocardial mapping using multielectrode catheters. Changes in epicardial electrograms were evaluated during single endocardial extrastimulation and after low-dose ajmaline infusion (0.5 mg/kg in 5 minutes).. All patients had a region in the anterior epicardial right ventricle with prolonged multicomponent electrograms. Single extrastimulation prolonged late epicardial components by 59 ± 31 ms and in 4 patients abolished epicardial components at some sites, without reactivation by surrounding activated sites. These localized blocks occurred at an initial coupling interval of 335 ± 58 ms and then expanded to other sites, being observed in up to 40% of epicardial sites. Ajmaline infusion prolonged electrogram duration in all and produced localized blocks in 62% of sites in the same patients as during extrastimulation. Epicardial conduction recovery after ajmaline occurred intermittently and at discontinuous sites and produced beat-to-beat changes in local repolarization, resulting in an area of marked electrical disparity. These changes were consistent with models based on microstructural alterations under critical propagation conditions.. In BrS, localized functional conduction blocks occur at multiple epicardial sites and with variable patterns, without being reactivated from the surrounding sites.

Topics: Action Potentials; Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Heart Block; Humans; Male; Middle Aged

The mechanisms by which sodium channel blockade and high-rate pacing modify electrogram (EGM) substrates of Brugada syndrome (BrS) have not been elucidated.. The purpose of this study was to determine the effect of ajmaline and high pacing rate on the BrS substrates.. Thirty-two patients with BrS (mean age 40 ± 12 years) and frequent ventricular fibrillation episodes underwent right ventricular outflow tract substrate electroanatomical and electrocardiographic imaging (ECGI) mapping before and after ajmaline administration and during high-rate atrial pacing. In 4 patients, epicardial mapping was performed using open thoracotomy with targeted biopsies.. Ajmaline increased the activation time delay in the substrate (33%; P = .002), ST-segment elevation in the right precordial leads (74%; P < .0001), and the area of delayed activation (170%; P < .0001), coinciding with the increased substrate size (75%; P < .0001). High atrial pacing rate increased the abnormal EGM duration at the right ventricular outflow tract areas from 112 ± 48 to 143 ± 66 ms (P = .003) and produced intermittent conduction block and/or excitation failure at the substrate sites, especially after ajmaline administration. Biopsies from the 4 patients with thoracotomy showed epicardial fibrosis where EGMs were normal at baseline but became fractionated after ajmaline administration. In some areas, local activation was absent and unipolar EGMs had a monophasic morphology resembling the shape of the action potential.. Sodium current reduction with ajmaline severely compromises impulse conduction at the BrS fibrotic substrates by producing fractionated EGMs, conduction block, or excitation failure, leading to the Brugada ECG pattern and favoring ventricular fibrillation genesis.

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Humans; Middle Aged; Sodium Channel Blockers; Ventricular Fibrillation

The aim of this study was to investigate the reliability of a novel electrocardiographic (ECG) marker in predicting ventricular arrhythmia (VA) inducibility in individuals with drug-induced Brugada syndrome (BrS) type I pattern. Consecutive patients with drug-induced type I BrS pattern underwent programmed ventricular stimulation (PVS) and, according to their response, were divided into 2 groups. Clinical characteristics and 12-lead ECG intervals before and after ajmaline infusion were compared between the 2 groups. A novel ECG marker named dST-Tiso interval consisting in the interval between the onset of the coved ST-segment elevation and its termination at the isoelectric line was also evaluated. Our cohort included 76 individuals (median age 44 years, 75% male). Twenty-five (32.9%) had VA inducibility requiring defibrillation. As compared with not inducible subjects, those with VA inducibility were more frequently male (92% vs 65%, p = 0.013), had longer PQ interval (basal: 172 vs 152 ms, p = 0.033; after ajmaline: 216 vs 200 ms, p = 0.040), higher J peak (0.6 vs 0.5 mV, p = 0.006) and longer dST-Tiso (360 vs 240 ms, p < 0.001). The dST-Tiso showed a C-statistics of 0.90 (95% confidence interval: 0.82 to 0.99) and an adjusted odds ratio for VA of 1.03 (1.01 to 1.04, p < 0.001). A dST-Tiso interval >300 ms yielded a sensitivity of 92.0%, a specificity of 90.2%, positive and negative predictive values of 82.1% and 95.8%. In conclusion, the dST-Tiso interval is a powerful predictor of VA inducibility in drug-induced BrS type I pattern. External validation is needed, but this marker might be useful in the clinical counseling process of these individuals before invasive PVS.

Topics: Adult; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results

Concomitant apamin-sensitive small conductance calcium-activated potassium current (I. The purpose of this study was to test the hypotheses that acetylcholine (ACh), the parasympathetic transmitter, activates I. We performed optical mapping in Langendorff-perfused rabbit hearts and whole-cell voltage clamp to determine I. ACh (1 μM) + ajmaline (2 μM) induced J-point elevations in all (6 male and 6 female) hearts from 0.01± 0.01 to 0.31 ± 0.05 mV (P<.001), which were reduced by apamin (specific I. ACh activates ventricular I

Topics: Acetylcholine; Ajmaline; Animals; Arrhythmias, Cardiac; Cholinergic Agonists; Disease Models, Animal; Heart Ventricles; Isolated Heart Preparation; Myocytes, Cardiac; Optical Imaging; Patch-Clamp Techniques; Potassium Channels, Calcium-Activated; Rabbits; Small-Conductance Calcium-Activated Potassium Channels; Sodium Channels; Voltage-Gated Sodium Channel Blockers

Short QT (SQT) syndrome is a genetic cardiac disorder characterized by an abbreviated QT interval of the patient's electrocardiogram. The syndrome is associated with increased risk of arrhythmia and sudden cardiac death and can arise from a number of ion channel mutations. Cardiomyocytes derived from induced pluripotent stem cells generated from SQT patients (SQT hiPSC-CMs) provide promising platforms for testing pharmacological treatments directly in human cardiac cells exhibiting mutations specific for the syndrome. However, a difficulty is posed by the relative immaturity of hiPSC-CMs, with the possibility that drug effects observed in SQT hiPSC-CMs could be very different from the corresponding drug effect in vivo. In this paper, we apply a multistep computational procedure for translating measured drug effects from these cells to human QT response. This process first detects drug effects on individual ion channels based on measurements of SQT hiPSC-CMs and then uses these results to estimate the drug effects on ventricular action potentials and QT intervals of adult SQT patients. We find that the procedure is able to identify IC50 values in line with measured values for the four drugs quinidine, ivabradine, ajmaline and mexiletine. In addition, the predicted effect of quinidine on the adult QT interval is in good agreement with measured effects of quinidine for adult patients. Consequently, the computational procedure appears to be a useful tool for helping predicting adult drug responses from pure in vitro measurements of patient derived cell lines.

Topics: Action Potentials; Adult; Ajmaline; Algorithms; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cell Line; Computational Biology; Drug Evaluation, Preclinical; Electrocardiography; ERG1 Potassium Channel; Heart Conduction System; Heart Defects, Congenital; Humans; In Vitro Techniques; Induced Pluripotent Stem Cells; Ivabradine; Mexiletine; Models, Cardiovascular; Mutation; Myocytes, Cardiac; Quinidine; Translational Research, Biomedical

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Humans; Prospective Studies

Familial evaluation after a sudden death with negative autopsy (sudden arrhythmic death syndrome; SADS) may identify relatives at risk of fatal arrhythmias.. This study aimed to assess the impact of systematic ajmaline provocation testing using high right precordial leads (RPLs) on the diagnostic yield of Brugada syndrome (BrS) in a large cohort of SADS families.. Three hundred three SADS families (911 relatives) underwent evaluation with resting electrocardiogram using conventional and high RPLs, echocardiography, exercise, and 24-h electrocardiogram monitor. An ajmaline test with conventional and high RPLs was undertaken in 670 (74%) relatives without a familial diagnosis after initial evaluation. Further investigations were guided by clinical suspicion.. An inherited cardiac disease was diagnosed in 128 (42%) families and 201 (22%) relatives. BrS was the most prevalent diagnosis (n = 85, 28% of families; n = 140, 15% of relatives). Ajmaline testing was required to unmask the BrS in 97% of diagnosed individuals. The use of high RPLs showed a 16% incremental diagnostic yield of ajmaline testing by diagnosing BrS in an additional 49 families. There were no differences of the characteristics between individuals and families with a diagnostic pattern in the conventional and the high RPLs. On follow-up, a spontaneous type 1 Brugada pattern and/or clinically significant arrhythmic events developed in 17% (n = 25) of the concealed BrS cohort.. Systematic use of ajmaline testing with high RPLs increases substantially the yield of BrS in SADS families. Assessment should be performed in expert centers where patients are counseled appropriately for the potential implications of provocation testing.

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Autopsy; Brugada Syndrome; Death, Sudden, Cardiac; Electrocardiography; Family; Female; Genetic Predisposition to Disease; Genetic Testing; Humans; Male; Reproducibility of Results; United Kingdom; Voltage-Gated Sodium Channel Blockers

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Humans; Mutation; NAV1.5 Voltage-Gated Sodium Channel; Sodium Channel Blockers

This study sought to test the hypothesis that elimination of sites of abnormal repolarization, via epicardial RFA, suppresses the electrocardiographic and arrhythmic manifestations of BrS.. Brugada syndrome (BrS) is associated with ventricular tachycardia and ventricular fibrillation leading to sudden cardiac death. Nademanee et al. reported that radiofrequency ablation (RFA) of right ventricular outflow tract epicardium significantly reduced the electrocardiogram and arrhythmic manifestations of BrS. These authors concluded that low-voltage fractionated electrogram activity and late potentials are caused by conduction delay within the right ventricular outflow tract and that the ameliorative effect of RFA is caused by elimination of this substrate. Szel et al. recently demonstrated that the abnormal electrogram activity is associated with repolarization defects rather than depolarization or conduction defects.. Action potentials (AP), electrograms, and pseudoelectrocardiogram were simultaneously recorded from coronary-perfused canine right ventricular wedge preparations. Two pharmacological models were used to mimic BrS genotype: combination of I. Fractionated low-voltage electrical activity was observed in right ventricular epicardium but not endocardium as a consequence of heterogeneities in the appearance of the second upstroke of the epicardial AP. Discrete late potentials developed as a result of delay of the second upstroke of the AP and of concealed phase 2 re-entry. Epicardial RFA of these abnormalities normalized Brugada pattern and abolished arrhythmic activity, regardless of the pharmacological model used.. Our results suggest that epicardial RFA exerts its ameliorative effect in the setting of BrS by destroying the cells with the most prominent AP notch, thus eliminating sites of abnormal repolarization and the substrate for ventricular tachycardia ventricular fibrillation.

Topics: Action Potentials; Ajmaline; Animals; Arrhythmias, Cardiac; Brugada Syndrome; Disease Models, Animal; Dogs; Electrocardiography; Humans; Pinacidil; Radiofrequency Ablation; Treatment Outcome

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Electrocardiography; Humans; ST Elevation Myocardial Infarction

The early repolarization (ER) pattern is associated with sudden death and has been shown to be heritable. Its significance when identified in families affected by sudden arrhythmic death syndrome (SADS) remains unclear.. We analyzed 12-lead ECGs of 401 first-degree relatives of individuals who had died from SADS. The prevalence of ER patterns was compared with family-clustered controls. ER was more common in SADS family members than in controls (21% versus 8%; odds ratio: 5.14; 95% confidence interval, 3.37-7.84) independent of the presence of a familial cardiac diagnosis. Both ascending and horizontal ER patterns were more common. In addition, ER was investigated for associations with findings from ajmaline provocation (n=332), exercise ECG (n=304), and signal-averaged ECG (n=118) when performed. ER was associated with a trend toward late depolarization, in general was suppressed with exercise and was unaffected by ajmaline. Inferior and horizontal patterns were, however, more likely to persist during exercise. Augmentation of ER with ajmaline was rare.. The ER pattern is more common in SADS family members than controls adjusted in particular for relatedness. The increased prevalence is irrespective of ER subtype and the presence of other inherited arrhythmia syndromes. ER may therefore represent an underlying heritable arrhythmia syndrome or risk factor for sudden death in the context of other cardiac pathology. The differing response of ER subtypes to exercise and ajmaline provocation suggests underlying mechanisms of both abnormal repolarization and depolarization.

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Case-Control Studies; Death, Sudden; Death, Sudden, Cardiac; Electrocardiography; Female; Humans; Male; Prevalence; Risk Factors

Sudden arrhythmic death syndrome defines a sudden unexpected and unexplained death despite comprehensive pathological and toxicological investigation. Previous studies have focused on evaluation of adult relatives. There is, however, a lack of data in children, leading to highly variable management. We sought to determine the clinical utility of cardiac evaluation in pediatric relatives of sudden arrhythmic death syndrome probands.. Retrospective review was undertaken of pediatric patients with a family history of sudden arrhythmic death syndrome assessed from 2010 to 2013 in 2 centers. Clinical history, cardiac, and genetic investigations were assessed, including diagnoses made after evaluation of adult relatives. A total of 112 pediatric relatives from 61 families were evaluated (median age at presentation, 8 years; range, 0.5-16 years). A probable diagnosis was made in 18 (29.5%) families: Brugada syndrome, 13/18 (72%); long QT syndrome, 3/18 (17%); and catecholaminergic polymorphic ventricular tachycardia, 2/18 (11%). Genetic testing identified mutations in 20% of Brugada syndrome (2/10) and 50% of long QT syndrome (1/2) and catecholaminergic polymorphic ventricular tachycardia families (1/2) who were tested. Pediatric evaluation diagnosed 6/112 relatives (5.4%), increasing to 7% (6/85) if only first-degree relatives were assessed. The only useful diagnostic tests were the 12-lead and exercise electrocardiograms and ajmaline provocation test. The median duration of follow-up was 2.1 years (range, 0.2-8.2 years) with no cardiac events.. The yield of evaluating pediatric relatives is significant and higher when focused on first-degree relatives and on conditions usually expressed in childhood. We propose a management pathway for these children.

Topics: Adolescent; Adult; Age Factors; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Brugada Syndrome; Child; Child, Preschool; Death, Sudden, Cardiac; Electrocardiography; Female; Genetic Predisposition to Disease; Genetic Testing; Humans; Infant; London; Long QT Syndrome; Male; Middle Aged; Pedigree; Phenotype; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Tachycardia, Ventricular; Time Factors; Young Adult

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Brugada Syndrome; False Positive Reactions; Humans; Reproducibility of Results; United Kingdom

The typical Brugada ECG pattern consists of a prominent J-wave associated with ST-segment elevation localized in the right precordial leads V1-V3. In many patients, the ECG presents periods of transient normalization and the Brugada-phenotype can be unmasked by the administration of class-I antiarrhythmics. Reports have documented the heterogeneity of the Brugada syndrome ECG-phenotype characterized by unusual localization of the ECG abnormalities in the inferior leads. Case report A 51-year-old man, without detectable structural heart disease, was referred to us because of a history of syncope, dizziness, and palpitations. The ECG showed a J-wave and ST-segment elevation in the right precordial leads, suggesting Brugada syndrome. As other causes of the ECG abnormalities were excluded, the patient underwent an electrophysiological study that documented easy induction of ventricular fibrillation. During infusion of ajmaline, new prominent J-waves and ST-segment elevation appeared in the inferior leads, whereas the basal ECG abnormalities in the right precordial leads normalized. After infusion of isoprenaline, the ECG-pattern resumed the typical Brugada pattern. An implantable cardioverter-defibrillator was recommended.. In our patient, the double localization of the typical Brugada-pattern and the paradoxical effect of ajmaline on the ECG abnormalities confirmed the possibility of a phenotype heterogeneity in the Brugada syndrome.

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Dizziness; Electrocardiography; Humans; Male; Middle Aged; Syncope; Syndrome

Sodium channel-blocking agents are routinely used to unveil the Brugada syndrome in patients in whom the typical electrocardiographic pattern is absent or doubtful. In this article, the authors report a patient with syncopal episodes of unknown origin in whom the conventional electrocardiographic result was normal and a negligibly small "saddle back" type repolarization was present in lead V2 recorded 2 intercostal spaces above the conventional site. Intravenous ajmaline (50 mg) did not elicit the type 1 pattern of the Brugada syndrome in the precordial leads obtained at their usual level, but a clear-cut coved-type repolarization was apparent in high right precordial leads. These findings indicate that high precordial leads should be routinely recorded while assessing the ajmaline test in patients suspected of having the Brugada syndrome.

Topics: Adult; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Defibrillators, Implantable; Electrocardiography; Female; Humans; Injections, Intravenous; Sodium Channel Blockers; Syncope; Syndrome; Vectorcardiography

Brugada syndrome is characterized by sudden death secondary to malignant arrhythmias and the presence of ST segment elevation in leads V(1) to V(3) of patients with structurally normal hearts. This ECG pattern often is concealed but can be unmasked using potent sodium channel blockers. Like congenital long QT syndrome type 3 (LQT3) and sudden unexpected death syndrome, Brugada syndrome has been linked to mutations in SCN5A.. We screened a large European family with Brugada syndrome. Three members (two female) had suffered malignant ventricular arrhythmias. Ten members showed an ECG pattern characteristic of Brugada syndrome at baseline, and eight showed the pattern only after administration of ajmaline (total 12 female). Haplotype analysis revealed that all individuals with positive ECG at baseline shared the SCN5A locus. Sequencing of SCN5A identified a missense mutation, R367H, previously associated with sudden unexpected death syndrome. Two of the eight individuals who displayed a positive ECG after the administration of ajmaline, but not before, did not have the R367H mutation, and sequencing analysis failed to identify any other mutation in SCN5A. The R367H mutation failed to generate any current when heterologously expressed in HEK cells.. Our results support the hypothesis that (1) sudden unexpected death syndrome and Brugada syndrome are the same disease; (2) male predominance of the phenotype observed in sudden unexpected death syndrome does not apply to this family, suggesting that factors other than the specific mutation determine the gender distinction; and (3) ajmaline may provide false-positive results. These findings have broad implications relative to the diagnosis and risk stratification of family members of patients with the Brugada syndrome.

Topics: Adult; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bundle-Branch Block; Comorbidity; Death, Sudden; Electrocardiography; Female; Genetic Predisposition to Disease; Humans; Male; Mutation, Missense; NAV1.5 Voltage-Gated Sodium Channel; Pedigree; Phenotype; Sex Distribution; Sodium Channels; Spain; Syndrome

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bundle-Branch Block; Comorbidity; Death, Sudden; Electrocardiography; Genetic Predisposition to Disease; Mutation, Missense; NAV1.5 Voltage-Gated Sodium Channel; Pedigree; Phenotype; Sex Distribution; Sodium Channels; Spain; Syndrome

Some newer cardiac pacemakers are able to control the efficacy of the ventricular pacing pulse beat by beat and to adjust the ventricular output to the actual pacing threshold. This capture verification is based on the detection of the ventricular evoked response amplitude, which has to be detected immediately after the pacing pulse. The sensitivity of the pacemaker to detect the evoked response amplitude must be adjusted individually to avoid the simultaneous detection of lead polarization. The aim of the present study was to evaluate the acute effects of a class IA antiarrhythmic drug on the evoked response amplitude and polarization in 13 pacemaker patients. The implanted pacemaker was the VVIR pacemaker Regency (St. Jude Medical), which provides the automatic capture verification algorithm Autocapture. The patients received 50 mg of ajmaline intravenously within 1 min. The evoked response amplitude and polarization were measured before and 2, 4, 6 and 8 min after ajmaline injection. The evoked response amplitude significantly decreased from 8.0 +/- 4.0 mV to a minimum value of 6.4 +/- 3.1 mV 2 min after drug administration. The decrease remained significant from the end of the application up to 6 min. The recommended sensitivity setting for the evoked response significantly (p < 0.05) decreased from 4.0 +/- 2.3 mV before to 3.1 +/- 1.3 mV 2 min after administration. No significant changes were observed for polarization. After the ajmaline application in 2 patients, the pacemaker recommended the deactivation of Autocapture for 9 min in 1 patient and 12 min in the other. The reasons were a decrease in the evoked response amplitude from 3.1 to 1.9 mV and from 9.0 to 5.7 mV, respectively, with a polarization ranging to about 3.0 mV. In conclusion, the ajmaline injection decreased the evoked response amplitude for some minutes. These findings indicate that antiarrhythmic drugs can alter the automatic capture verification function.

Topics: Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiac Pacing, Artificial; Evoked Potentials; Female; Humans; Male; Middle Aged; Pacemaker, Artificial; Sensitivity and Specificity

The aim of this retrospective study was to determine the mechanism of syncope in idiopathic hypertrophic cardiomyopathy (HCM). An electrocardiographic study was undertaken in 43 patients with HCM: 27 (Group I) had a history of syncope and 16 (Group II) had no history of syncope but were investigated for conduction defects (n = 7) or unsustained ventricular tachycardia (VT) (n = 9). The stimulation protocol used programmed atrial pacing with 1 and 2 extrastimuli and ventricular pacing using up to 3 extrastimuli delivered at 2 sites. The following results were obtained: sustained atrial fibrillation (AF) (> 1 min) was induced in 21 patients in Group I (78%), 4 in Group II (25%); VT was induced in 3 patients in Group I (11%), and 3 in Group II (19%); infra-Hisian block was detected in 1 patient in Group I. The mechanism of syncope was elucidated in 23 patients in Group I (85%): one atrioventricular block 1 sinus node dysfunction, 18 atrial fibrillations, 2 associations of AF-VT and 1 VT. The authors conclude that the prevalence of inducible AF was higher in patients with HCA and syncope than in controls and HCM without syncope: this was the only detectable difference in 67% of patients with unexplained syncope. Paroxysmal AF could therefore explain malaise or syncope in up to 2/3 of cases of HCM.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiomyopathy, Hypertrophic; Female; Humans; Isoproterenol; Male; Middle Aged; Retrospective Studies; Syncope

Topics: Ajmaline; Arrhythmias, Cardiac; Drug Resistance; Humans; Lidocaine; Myocardial Infarction; Thrombolytic Therapy

The conventional experimental techniques showed that ajmaline derived from Rouwolfia serpentina Benth. biomass grown in tissue culture was effective in arresting canine ventricular arrhythmias induced by coronary occlusion, strophanthin and epinephrine, displaying antiarrhythmic effects in aconitine-induced intoxication of rats and substantially elevating the threshold of ventricular fibrillations in cats. The antiarrhythmic activity of ajmaline produced by the biotechnological technique was identical to that of ajmaline derived from the natural root of Rauwolfia serpentina Benth, which allows one to recommend that the agent in question should be clinically tested as an antiarrhythmic.

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Cats; Culture Techniques; Dogs; Mice; Plants, Medicinal; Rats; Rats, Inbred Strains; Rauwolfia

We studied the effects of prajmaliumbitartrate (PBT, Neo-Gilurytmal, Giulini Pharma, Hannover, FRG), an antiarrhythmic drug on some parameters of blood coagulation in patients. PBT, 20 mg given three times a day, significantly prolonged template bleeding time and ex vivo thrombus formation time in a modified Chandler's loop. Ex vivo platelet aggregation using different agonists and tests of the plasmatic coagulation system remained unchanged.

Topics: Ajmaline; Arrhythmias, Cardiac; Bleeding Time; Blood Coagulation Tests; Humans; Middle Aged; Platelet Aggregation; Platelet Count; Platelet Function Tests; Prajmaline

A 23-year-old woman was hospitalized because of life-threatening monomorphic ventricular tachycardia (VT) of 150 beats/min. An intravenous bolus of lidocaine was without effect but 25 mg ajmaline converted the tachycardia to sinus rhythm. A total of 70 mg ajmaline was subsequently infused because of frequent ventricular premature systoles. During this treatment polymorphic VT with very wide QRS complexes developed, but spontaneously disappeared after ajmaline had been discontinued. The case demonstrates the need for taking into account the potential risk of a proarrhythmic effect of anti-arrhythmic drugs.

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Female; Humans; Infusions, Intravenous; Lidocaine; Sotalol; Tachycardia

1. Antiarrhythmic actions of ajmaline against ischaemia (left coronary artery occlusion for 15 min) and subsequent reperfusion-induced arrhythmias were investigated in anaesthetized rats. 2. Ajmaline (2 mg kg-1, i.v.) was effective in suppressing ischaemia-induced arrhythmias whether given pre- or post-occlusion. 3. Ajmaline diminished the reperfusion-induced arrhythmias completely when given pre-occlusion but had little effect when given post-occlusion. 4. Reperfusion-induced increases in plasma enzyme activities of lactate dehydrogenase, glutamate-oxaloacetate transaminase and creatine phosphokinase were prevented more effectively when ajmaline was given pre-occlusion rather than post-occlusion. 5. Fifteen min post-occlusion, the ajmaline concentrations in the ischaemic ventricle were 18.42 +/- 1.66 and 1.18 +/- 0.15 micrograms g-1 for pre- and post-occlusion administration, respectively. However, ajmaline concentrations in whole blood and normal ventricle were not significantly different between pre- and post-occlusion administration. 6. We suggest that the beneficial effect of ajmaline against reperfusion-induced arrhythmias is related to the ischaemic myocardial concentration of ajmaline which is markedly affected by the time of drug administration (i.e. pre- and post-occlusion).

Topics: Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Aspartate Aminotransferases; Coronary Circulation; Coronary Disease; Creatine Kinase; Electrocardiography; L-Lactate Dehydrogenase; Male; Myocardium; Rats; Rats, Inbred Strains

The acute effect of ajmaline was investigated in the treatment of postoperative ventricular arrhythmias. Ajmaline (Glurytmal--Giulini Pharma GMBH) was applied intravenously in 15 patients suffering from ventricular premature beats (Lown II--IV/b), tachycardia and/or ventricular fibrillation after open heart surgery. Ajmaline infusion produced in 40% of the cases a total suppression and in 100% a significant improvement of malignant ventricular arrhythmia. In patients with recurrent and resistant ventricular tachycardia, ajmaline proved effective even when other antiarrhythmic drugs had failed. It was shown to be effective in reducing ventricular premature contractions and recurrent ventricular tachycardia after heart surgery, without haemodynamic side effects. Because of recurrent ventricular premature beats in 11 patients after acute ajmaline administration further oral application of prajmalium bitartarate (Neo-Gilurytmal) was necessary. The maintenance of these patients on oral ajmaline treatment seemed important.

Topics: Adolescent; Adult; Ajmaline; Arrhythmias, Cardiac; Child; Female; Heart Conduction System; Heart Diseases; Heart Ventricles; Humans; Male; Middle Aged; Postoperative Complications

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Female; Heart Ventricles; Humans; Male; Middle Aged; Prajmaline

Topics: Ajmaline; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Cholestasis; Diagnosis, Differential; Humans; Male; Middle Aged; Prajmaline

The antiarrhythmic effects of verapamil, 17-monochloracetylajmaline, mexiletine and amiodarone were compared in 14 patients with chagasic myocarditis. Drugs and placebo were administered orally in the following order: placebo and verapamil, placebo and 17-monochloracetylajmaline, placebo and mexiletine (1 week each) and placebo and amiodarone (4 weeks each). A 24 hour ambulatory electrocardiographic recording was obtained after administration of each placebo and drug. Verapamil had no effect on the number of ventricular premature complexes, ventricular couplets and runs of ventricular tachycardia. 17-Monochloracetylajmaline did not reduce the number of ventricular premature complexes and ventricular couplets but caused a moderate reduction in runs of ventricular tachycardia. Mexiletine failed to significantly reduce ventricular premature complexes but caused a moderate decrease in both ventricular couplets and runs of ventricular tachycardia. Amiodarone was the only one of the four drugs that caused a substantial reduction of ventricular premature complexes (logarithmic mean 97.8%; p less than 0.001), total suppression of runs of ventricular tachycardia in 11 of 11 patients and suppression of ventricular couplets in 8 of 14 patients and a significant reduction in the remaining 6 patients. The much greater efficacy of amiodarone as compared with the two sodium channel modifiers (17-monochloracetylajmaline and mexiletine) and one calcium channel blocker (verapamil) suggests that its potent antiarrhythmic activity is probably related to other peculiar and still undefined electrophysiologic and pharmacologic properties.

Topics: Adult; Ajmaline; Amiodarone; Arrhythmias, Cardiac; Benzofurans; Chagas Cardiomyopathy; Female; Humans; Male; Mexiletine; Middle Aged; Placebos; Propylamines; Verapamil

Bepridil has been shown to block both slow- and fast-channel activity in the heart. Electrophysiologic studies in man demonstrate that oral and intravenous bepridil prolongs sinus cycle length, PR interval and QT interval, without apparently changing the QRS interval. In addition, the drug depresses atrioventricular (AV) nodal conduction, resulting in an increased AH interval. Refractoriness in the AV node, atrium and ventricle is increased. There is usually little or no change in the HV interval. The antiarrhythmic properties of bepridil have been noted in patients with supraventricular tachycardia, ventricular premature complexes (VPCs) and sustained ventricular tachycardia (VT). In 17 patients, intravenous bepridil was compared with either verapamil or ajmaline. AV nodal reentrant tachycardia was terminated in all patients with bepridil and verapamil. However, ajmaline was somewhat more effective than bepridil in patients with AV reentry (8 of 8 versus 5 of 8). In 12 of these 17 patients, oral bepridil (500 mg/day for 3 days) suppressed the induction of tachycardia or slowed its rate. In 3 studies of oral bepridil for VPCs, the drug was effective in 68%, 69% and 70% of patients. Another group of studies evaluated bepridil in a total of 30 patients with sustained VT. Intravenous bepridil terminated VT in 17 of 26 patients. The induction of VT by programmed ventricular stimulation was also prevented in 7 of 17 patients. Although torsade de pointes has been reported, its incidence appears to be low.

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bepridil; Calcium Channel Blockers; Electrocardiography; Electrophysiology; Heart Conduction System; Heart Rate; Humans; Pyrrolidines; Tachycardia; Verapamil

The widespread use of antiarrhythmic agents to control severe life-threatening arrhythmias evidenced the possibility of a worsening of arrhythmias induced by the same drugs. We performed a retrospective analysis studying the worsening phenomenon in patients who underwent pharmacological invasive and non invasive antiarrhythmic tests to choose the drug to be administered in the chronic treatment. Particularly we reviewed: 101 acute pharmacologic non invasive tests for "stable" ventricular ectopic beats using computerized automatic continuous recording system which allows quantitative and qualitative evaluation of arrhythmias. The drugs tested were: Propafenone (25 patients), Disopiramide (25 patients), Tocainide (11 patients), Lorcainide (8 patients), Lorajmine (13 patients), Nadolol (9 patients). In accordance with Vallebit et al., we considered arrhythmias worsening criteria: the onset of non sustained or sustained ventricular tachycardia; an increase of four fold the number of ventricular ectopic beats and/or ten fold the repetitive forms. A worsening of arrhythmias was observed in 4/101 (3.9% patients); 1/9 treated with Nadolol, 1/25 with Propafenone, 1/35 with Disopiramide, 1/13 with Lorajmine. For one young patient the worsening phenomenon could be considered a toxic picture, because of the very high drug plasmatic levels (Lorajmine) observed for the whole duration of the sustained VT induced from the drug. For the remaining 3 patients the response resambles a paradox effect. 34 pharmacologic invasive tests in 30 patients with common recurrent ventricular tachycardia, during electrophysiologic endocavitary study. The drugs tested were: Propafenone (12 patients), Amiodarone (11 patients), Ajmaline (4 patients), Tocainide (3 patients), Lorcainide (2 patients), Lorajmine (1 patient), Disopiramide (1 patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Benzeneacetamides; Child; Disopyramide; Female; Follow-Up Studies; Humans; Lidocaine; Male; Middle Aged; Nadolol; Piperidines; Propafenone; Propanolamines; Propiophenones; Tocainide

Seven further cases with n-propyl-ajmaliumbitartrate (NPAB)-associated liver damage observed between 1976 and 1980 in two collaborating institutions are reported. The cause/effect relationship could be classified as probable in three cases and as potential in the remaining four patients. No drug rechallenge was carried out. In the clinical management, definite exclusion of biliary tract obstruction had a clear priority over histologic documentation of the degree of the transient liver damage. Follow-up data after 2 years 8 months to 5 years 9 months by personal reinvestigation of three patients and by questionnaire to family physicians and patients in the remaining four cases gave no clinical or serologic indication of persisting or relapsing liver damage. Liver biopsies were not considered to be warranted in the follow-up of these asymptomatic patients with normal liver function tests.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Female; Follow-Up Studies; Humans; Liver Function Tests; Male; Middle Aged; Prajmaline

The material has been collected in the course of two years and covers 48 cases with paroxysms of supraventricular paroxysmal tachycardia (28), auricular fibrillation (4) ventricular tachycardia (2), group and polytopic ventricular extrasystoles (14), organic cardiac diseases (30) and 18--inorganic heart diseases. Paroxysms were interrupted by isolamid, tachmalin lidocain via slow intravenous infusion with constant ECG, auscultation and hemodynamic control, monitor follow up. The paroxysms successfully coped were 43. It proved possible to interrupt the rhythm disorders under the conditions of non-integrated polyclinic provided the functional consulting room is well equipped. The problem of early and effective treatment of rhythm disorders even under polyclinical conditions is solved, thus avoiding the unnecessary hospitalization of some of those patients and delay in the effective treatment of the other part of the patients. The early diagnosis and proper therapeutic behaviour of the physician towards the patient from the very first moment of contact to the transportation and hospitalization of the patient is of vital importance. The interruption of rhythm disorders must very cautiously be performed--the ventricular tachycardia and polytopic extrasystoles in particular, that considered only an introductory treatment.

Topics: Adult; Ajmaline; Ambulatory Care; Arrhythmias, Cardiac; Cardiac Glycosides; Electrocardiography; Female; Humans; Infusions, Parenteral; Lanatosides; Lidocaine; Male; Middle Aged

His bundle study with long term follow-up (mean 42 months) was performed in 155 patients (107 with previous syncope, 48 without or with few symptoms). The electrocardiogram showed various conduction abnormalities, but in some cases it was normal. Patients were excluded at the beginning of the study, if they showed sick sinus syndrome, recorded 3rd degree atrioventricular block, angina pectoris, recent myocardial infarction, congenital or surgical cardiac block. In previous studies the diagnostic sensibility and specificity of ajmaline (1 mg/kg/1' i.v.) and overdriving tests have been evaluated. In this study the prognostic meaning of these tests has been evaluated. During a mean 42 months follow-up, 17 patients (10.9%) developed advanced atrioventricular block. A higher risk of developing advanced atrioventricular block below the AV node was detected in patients who showed: basal HV greater than or equal to 65 ms (33% developed advanced atrioventricular block vs 4.7% of patients with basal HV less than 65 ms; p less than 0.001); HV value greater than or equal to 120 ms or 2nd-3rd degree atrioventricular block during ajmaline test (40% progressed to advanced atrio-ventricular block vs 0.85%; p less than 0.001); HV prolonged greater than 10 ms or 2nd-3rd degree atrioventricular block during atrial pacing (40% progressed to a atrioventricular block vs 3.4%; p less than 0.001) regardless of previous syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Bundle of His; Electrocardiography; Electrophysiology; Follow-Up Studies; Heart Block; Humans; Middle Aged; Pacemaker, Artificial; Prognosis; Risk; Time Factors

The material has been collected for two years and covers 48 case with paroxysm of supraventricular paroxysmal tachycardia (28), auricular fibrillation (4), ventricular tachycardia (2), group and polytopic ventricular extrasystoles (14), with organic heart diseases (30) and with non-organic heart diseases (18). The paroxysms were coped with isolanid , tachmalin and lidocain , sow intravenous infusion under constant ECG, auscultatory and hemodynamic control and monitors. The number of the successfully coped paroxysms is 43. It proved to be possible to interrupt the rhythm disturbances under the conditions of non-integrated polyclinic in case of properly equipped functional consulting room. In this way the problem of early and effective treatment of rhythm disturbances under polyclinical conditions is solved, hence--avoiding both the unnecessary hospitalization of part of those patients and the delay in the initiation of effective treatment of the other part of them. The early diagnosis and adequate therapeutic behaviour of the physician towards the patient at their first contact till the moment of their transportation and hospitalization proved to be of particular significance. The out-patient department interruption of rhythm disorders should very cautiously be performed, particularly in case of ventricular tachycardia and polytopic extrasystoles, that being only their initial treatment.

Topics: Adult; Ajmaline; Ambulatory Care; Arrhythmias, Cardiac; Cardiac Glycosides; Electrocardiography; Female; Humans; Infusions, Parenteral; Lanatosides; Lidocaine; Male; Middle Aged; Monitoring, Physiologic

Seven cases of acute ajmaline overdose admitted over a 3 year period to a polyvalent intensive care unit are reported. The severity of this condition is related to the membrane stabilising and depolarising effects of ajmaline on the myocardium. The dose ingested varied from 10 to 40 mg/kg. The delay between ingestion and hospital admission ranged from 3 to 6 1/2 hours. The first cardiac disturbances can appear one hour after ingestion. Three cardiac arrests and one hypovolemic shock occurred. Three atrioventricular blocks, six intraventricular blocks, three ventricular tachycardias, and six prolongations of the QT interval were observed. Serum ajmaline levels varied from 0,8 to 6 mg/l. Symptomatic therapy was mainly based on sodium, temporary cardiac pacing, external DC shock, sympathomimetics and external cardiac massage with assisted ventilation. Cardiac bypass should be a part of the therapeutic arsenal. Elimination of the drug is assisted by a complete digestive evacuation. Renal or extrarenal dialysis is not indicated. One of the seven patients died. Prophylaxis is based on the non-prescription of ajmaline for benign cardiac disturbances.

Topics: Adolescent; Adult; Ajmaline; Arrhythmias, Cardiac; Child; Child, Preschool; Dose-Response Relationship, Drug; Electrocardiography; Female; Heart Conduction System; Hemodynamics; Humans; Metabolic Clearance Rate

Topics: Aged; Ajmaline; Analysis of Variance; Arrhythmias, Cardiac; Atrioventricular Node; Cardiac Pacing, Artificial; Electrocardiography; Heart Block; Heart Conduction System; Humans

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Benzeneacetamides; Electrocardiography; Female; Humans; Male; Middle Aged; Piperidines; Syncope; Time Factors

Programmed stimulation can now be safely performed for the evaluation of therapy for recurrent ventricular tachyarrhythmia. The initiation of ventricular tachycardia appears closely related to its actual spontaneous clinical occurrence. Serial electrophysiologic studies can be performed and are effective in prospectively evaluating the response to antiarrhythmic drugs. The efficacy of therapy based on the results of programmed stimulation appears to be good. On the other hand, Amiodarone can be effective in the chronic treatment as well as in patients with ineffective acute drug test.

Topics: Adult; Aged; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug Evaluation; Female; Humans; Male; Mexiletine; Middle Aged; Propafenone; Propiophenones; Tachycardia

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug Evaluation; Humans

A comparative and retrospective study of 59 cases of acute voluntary self-poisoning observed at the Toxicology Department of Fernand Widal Hospital, and 15 cases of complications of the Ajmaline test observed in the Cardiology Department of Bichat Hospital showed a similarity in the cardiac effects of high dosage regardless of the mode of administration of the antiarrhythmic. Acute suicidal poisoning in adults or accidental poisoning in children caused toxic effects at doses over more than Ig: they are characterised by their sudden onset after a latent period of 1 to 2 hours and their short duration (no effects after the 12th hour). The ECG changes included:--First degree atrioventricular block (15 p. 100).--Intraventricular conduction defects were observed in almost all cases. They were proportional to the dose taken and were of prognostic interes (no cardiac arrests when the QRS remained less then 0,2 sec).--ST-T wave changes were observed in all patients. They lasted longer and were of no prognostic importance.--Extrasystoles and ventricular tachycardia are nearly always associated with poor hemodynamic tolerance (70 p. 100 of cardiac arrests, compared to only 16 p. 100 in this absence). This intoxication is serious with a mortality of 24 p. 100 of the reported cases and of 9 p. 100 of cases admitted to an Intensive Care Unit.--The complications of the Ajmaline test were similar, the time of apparition being a few minutes instead of a few hours. There were no deaths or serious hemodynamic complications in this series. This is without doubt related to the observation of the contraindications and the fractional administration of the Ajmaline. We conclude that oral Ajmaline, though well tolerated at therapeutic does may cause severe toxic overdose effects. Although its use remains justified in the treatment of arrhythmias, it should not be used for the symptomatic treatment of palpitations and neurovegetative imbalance.

Topics: Acute Disease; Adult; Ajmaline; Arrhythmias, Cardiac; Child; Electrocardiography; Humans; Retrospective Studies; Suicide

Nine cases of major ventricular arrhythmia (tachycardia (VT), fibrillation (VF), torsades de pointe) are reported in patients with sequellae of myocardial infarction but without residual angina or cardiac failure. --Six of these disturbances of excitability occurred after a bradycardia due to sino atrial block (SAB) which favoured the breakthrough of abnormal automatic foci. This form of the bradycardia-tachycardia syndrome was demonstrated by endocavitary electrophysiological exploration.. These were the only cases of major ventricular arrhythmia observed in a series of 88 SABs. Reputedly benign, they illustrate the potential gravity of a conduction defect in patients with sequellae of myocardial infarction. --Three other cases of abnormal ventricular excitability complicating the administration of 1 mg/kg of Ajmaline to test for paroxysmal block after myocardial infarction. These were the only cases of VT observed in a series of 800 Ajmaline tests. The three patients have had no further episodes of VT after 1 year's follow-up. On the other hand, in 43 Ajmaline tests without VT in patients with myocardial infarction, 6 cases of VT and 1 lethal VF were later observed. This demonstrates the lack of significance of episodes of VT during Ajmaline tests, the depressant action of the drug on intracardiac conduction favouring the initiation of reentry. In conclusion, a history of myocardial infarction exposes the patient to the risk of major ventricular arrhythmias in SAB, the detection of which should indicate pacemaker therapy from the first symptoms. The use of an intravenous antiarrhythmic agent should be avoided as it may aggravate arrhythmias. However, the arrhythmia is of no prognostic significance.

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Female; Heart Block; Humans; Male; Myocardial Infarction; Prognosis; Sinoatrial Block

Topics: Acute Disease; Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Bunaftine; Female; Humans; Lidocaine; Male; Middle Aged; Phenytoin; Verapamil

The aim of Mobile Coronary Care Units (M.C.C.U.) is to reduce the delay in delivering intensive care to patients with a heart attack. In the city of Florence a M.C.C.U. has been available since November 1979. During the first year the staff of the M.C.C.U. has treated 158 cases of serious cardiac arrhythmias which occurred among 486 interventions. In 94 patients cardiac arrhythmias followed an acute coronary attack. In 64 patients coronary heart disease could not be demonstrated. This study concerns the latter group of patients. The mean age was 65.2 years and 39 patients (61%) were women. The mean time from the onset of the symptoms to the arrival of the M.C.C.U. team was 3h and 2 min, whereas the mean time from the call to the arrival was 14 min. Sixty patients had atrial arrhythmias (29 atrial fibrillation, 2 atrial flutter, 22 atrial tachycardia, 7 premature atrial contractions) and 4 patients had ventricular arrhythmias (1 ventricular tachycardia, 1 ventricular flutter, 2 premature ventricular contractions). In thirty-nine patients (61%) the cardiac arrhythmia was abolished by the staff of the M.C.C.U.. Of the remaining 28 patients, 10 were brought to the hospital and 18 were left at home. None of these needed later admission to the hospital. So the treatment at home of cardiac arrhythmias has been successful in the majority of patients. Bunaftine was the antiarrhythmic drug more frequently used (23 cases, 34%) with a high percentage of success (87%). In planning medical emergency services to the community, one can envisage the use of the M.C.C.U. facilities to treat at home those arrhythmias that are not associated with an acute coronary attack.

Topics: Adult; Aged; Ajmaline; Ambulances; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bunaftine; Coronary Care Units; Digoxin; Female; Humans; Italy; Male; Middle Aged; Verapamil

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Prajmaline

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Barbiturates; Drug Combinations; Female; Humans; Jaundice; Male; Middle Aged

The present study was designed to assess the antiarrhythmic Prajmalium Bitartrate (PB) efficacy in the long term treatment of 22 patients with recent myocardial infarction and persistent, frequent, polimorphous, repetitive (two or more in a row) ventricular premature complexes (VPCs). VPCs were exposed by means of 24-hours ambulatory monitoring. The acute drug testing with a single dose of PB (30 mg) was followed by multiple maintenance therapy with a dose decreasing from 60 to 40 mg every day. Than, the long term antiarrhythmic action was evaluated by both monitoring and exercise stress testing (EST), symptom self-limited, in a 7 months and 28 days follow-up. A favorable therapeutic effect, with a reduction of VPCs frequency greater than 85% and the suppression of their greater Lown degrees, was obtained in 13 cases (59.2%) using PB alone and in 6 cases (27.2%) using PB associated with Amiodarone in 5 patients and with Metoprololo in one. No VPCs were present or they were less than 2 every 3 minutes during EST. Fourteen patients reported a recurrence of VPCs when the drug was stopped for 24-28 hours, after 3-5 months of the treatment. In 3 patients (13.6%) the PB was uneffective. In a case there was, during the acute drug testing, a paradox increasing of the arrhythmias, and in the other two an abnormal lengthening of QTc interval, while arrhythmia was unchanged. PB, alone or associated with other antiarrhythmic drugs, appears a well tolerated, handy and effective agent and it can be proposed as a drug of first choice for controlling VPCs.

Topics: Adult; Aged; Ajmaline; Ambulatory Care; Amiodarone; Arrhythmias, Cardiac; Drug Therapy, Combination; Electrocardiography; Female; Humans; Male; Metoprolol; Middle Aged; Monitoring, Physiologic; Myocardial Infarction; Prajmaline

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Prajmaline

Topics: Adolescent; Ajmaline; Arrhythmias, Cardiac; Cardiomyopathy, Hypertrophic; Heart Ventricles; Humans; Male

Topics: Adrenergic beta-Antagonists; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Pacing, Artificial; Digoxin; Disopyramide; Electric Countershock; Humans; Phenytoin; Procainamide; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Verapamil

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Cholestasis, Intrahepatic; Drug Hypersensitivity; gamma-Glutamyltransferase; Humans; Liver Diseases; Male; Transaminases

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Drug Tolerance; Electrocardiography; Female; Humans; Male; Middle Aged; Tachycardia

Topics: Adolescent; Adult; Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Female; Humans; Male; Middle Aged; Prajmaline; Tachycardia, Paroxysmal

We present a case of overdosage of ajmaline in an infant. The appearance of atactic gait and clonic tonic seizures were followed by loss of consciousness, apnea, supraventricular tachycardia, left bundle-branch block, and a prolonged Q-T interval. Cardiopulmonary resuscitation, gastric lavage, and forced diuresis were followed by complete recovery. Continuous electrocardiographic monitoring is mandatory in these cases, and the use of a cardiac pacemaker, respirator, and therapy with antiarrhythmic agents should be considered.

Topics: Accidents, Home; Administration, Oral; Ajmaline; Apnea; Arrhythmias, Cardiac; Ataxia; Bundle-Branch Block; Consciousness Disorders; Diuresis; Electrocardiography; Female; Gastric Lavage; Humans; Infant; Monitoring, Physiologic; Resuscitation; Seizures; Sodium Chloride; Tablets; Tachycardia

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Female; Heart Ventricles; Humans; Injections, Intravenous

Topics: Ajmaline; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Cardiac Pacing, Artificial; Carotid Sinus; Digitalis Glycosides; Humans; Massage; Tachycardia, Paroxysmal; Valsalva Maneuver; Verapamil

The electrophysiological effects of ajmaline (1 mg/Kg i.v.) on sinus node were evaluated in 63 control subjects and in 12 pts with sick sinus syndrome (S.S.S.). In the control group the mean spontaneous cycle length (S.C.L.) was found significatively (less less than 0.001) reduced (8,?%), and corrected sinus node recovery time (C.S.N.R.T.) significatively (p less than 0.01) prolonged (30,2%) by the drug. In the patients with S.S.S. the S.C.L. was prolonged by 16% but not significatively and the C.S.N.R.T. by 60,7% (p less than 0.05). In 8/12 pts, with S.S.S. spontaneous sinoatrial blocks appeared or were more frequently observed following ajmaline injection. The use of ajmaline as a unic pharmacologic test for the differential diagnosis of symptomatic bradycardia in patients with atrioventricular associated conduction defects is discussed.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Bradycardia; Female; Heart Block; Humans; Male; Middle Aged; Tachycardia

The electrophysiological effects of ajmaline have been investigated using the intracardiac electrograms and the extrastimulus method. The drug was infused intravenously into 21 patients at the dose of 1 mg/Kg. Ajmaline induces:--variable effect on the sinusal cycle length--variable effect on the corrected sinus node recovery time--increase of the atrial effective refractory period (P less than 0.001)--in AV node slowing of conduction (P less than 0.001), a slight prolongation of PRE (P less 0.01) and more marked one of the FRP (P less than 0.001). The His-Purkinje (HV interval) and intraventicular (QRS interval) conduction times are prolonged (P less than 0.001), as well as the RRF of His-Purkinje system. The maxium increase of AH,HV and QRS intervals appears 3 minutes after drug administration; at the 5th minute these intervals have already slightly decreased, then they decrease almost quickly till the 15th minute and more slowly till the 30th minute. The absolute prolongation of the HV and QRS intervals is more marked in the patients in which these intervals are more prolonged during the control study, while the percentage increase is almost equal in the patients with normal HV and QRS interval and in those with prolonged HV and QRS intervals. The electrophysiological properties of the drug are discussed on the basis of the obtained results.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Drug Evaluation; Electrocardiography; Female; Heart Block; Heart Conduction System; Humans; Injections, Intravenous; Male; Middle Aged

Topics: Adrenergic beta-Antagonists; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Humans; Lidocaine; Quinidine; Syndrome; Tachycardia, Paroxysmal; Verapamil

The electrophysiological changes caused by the intra-atrial injection of 1.5 mg/kg of chloro-acetyl-ajmaline were studied in 23 patients by recording the His potential and by the stimulustest method. The length of the basal cycle being kept constant by atrial stimulation, measurements were made before and after the injection, on the one hand of the -VA node conduction time (A-H interval) and the infra-His conduction time (H-V interval) and on the other of the refractory periods of the right auricle, A-V node, and the His-Purkinje system. The effective refarctory period of the right ventricle was determined under pace-making of the ventricle. Finally, the variability of the sinus rate was measured. The results were as follows: 1. The sinus cycle was significantly shortened after administration of the drug (p 0.001); 2. The conduction time and refractory periods of the A-V node were not influenced by this substance; 3. The H-V interval was increased in 20 patients by an average of 11 ms (p less than 0.001). The relative refractory period of the His-Purkinje system was reduced in 4 cases out of 7 by 21 ms (p less than 0.05); the effective refractory period in one case showed a reduction of more than 45 ms. These findings will serve as a base line for assessing the anti-arrhythmic action of chloro-acetyl-ajmaline.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Bundle of His; Electrocardiography; Female; Heart Conduction System; Humans; Male; Middle Aged

The antiarrhythmic effect of PGE2 as compared with the adrenergic beta-receptor blocking substance propranolol and the unspecific antiarrhythmic agent ajmaline was examanined on catecholamine-induced arrhythmias of the guinea-pig after preliminary sensibilisation by means of chloroform. Prophylactic administration of the tested substances resulted in a decrease in severity of arrhythmia by 91% after propranolol, by 37% after PGE2 and by 34% after ajmaline. Onset and duration of the arrhythmia were affected only to a negligible degree. The possible mode of action is still under discussion.

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Catecholamines; Female; Guinea Pigs; Male; Propranolol; Prostaglandins E

Topics: Ajmaline; Arrhythmias, Cardiac; Myocardial Infarction

In two patients with supraventricular tachyarrhythmias with atrioventricular block, therapy with lidocaine and ajmaline decreased the atrioventricular block and caused paradoxic acceleration of the ventricular rate. Appropriate treatment of this hazardous result of therapy with antiarrhythmic drug is reviewed.

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Heart Block; Heart Conduction System; Heart Rate; Heart Ventricles; Humans; Lidocaine; Male; Tachycardia

Topics: Ajmaline; Arrhythmias, Cardiac; Heart Block; Humans; Hypnotics and Sedatives; Lidocaine; Pacemaker, Artificial; Procainamide; Quinidine; Sparteine; Verapamil

Topics: Ajmaline; Arrhythmias, Cardiac; Humans; Lidocaine; Procaine; Quinidine; Tachycardia

Electrophysiological studies were performed in a patient with a short P-R interval and a small delta wave. The findings suggest that ventricular pre-excitation resulted from an infranodal bypass (Mahaim type). As the functional properties of the pathway were evaluated, impaired conductivity (suggested by rather long refractory periods) became apparent at frequency stress. The pathway could easily be blocked by Ajmaline. This demonstrated an unexpected early diastolic improvement in conductivity; i.e. a supernormal phase of conduction. Due to this supernormal phase, Mahaim-fiber conduction was present when block in the anterior division of the left bundle branch, or even trifascicular block occurred. Thus the effects of exclusive Mahaim-fiber conduction on ventricular activation were documented.

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Atrioventricular Node; Bundle of His; Electrocardiography; Female; Heart Conduction System; Humans

Topics: Adrenergic beta-Antagonists; Ajmaline; Arrhythmias, Cardiac; China; Digitalis Glycosides; Electric Stimulation; Electric Stimulation Therapy; Heart Massage; History of Medicine; Humans; Medicine, East Asian Traditional; Quinine

Ajmaline, a rauwolfia derivative, has been found to possess potent antiarrhythmic effects. The present study has been designed to define the cardiovascular effects of this drug. Hemodynamic studies performed in anesthetized and conscious dogs demonstrated no significant changes in measured hemodynamic parameters at doses equal to or less than 2 mg. per kilogram. Studies in isolated papillary muscle demonstrated no negative inotropic effects until concentrations of 1 X 10(-4). Disparate results were obtained with regard to heart rate reflecting the state of autonomic tone. Electrophysiologic studies in both anesthetized and conscious dogs demonstrated a significant depression of intraventricular conduction with no significant effect on AV nodal conduction; ventricular automaticity was not affected. Ajmaline did not alter digitalis-induced AV nodal conduction prolongation. However, ajmaline dramatically altered or abolished ventricular arrhythmias secondary to acute ischemia. In conclusion, these studies demonstrate that ajmaline specifically depresses intraventricular conduction, suggesting that this drug would be particularly effective in the treatment of re-entrant ventricular arrhythmias.

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Atrioventricular Node; Cardiovascular System; Cats; Depression, Chemical; Digitalis; Dogs; Heart Conduction System; Heart Rate; Hemodynamics; In Vitro Techniques; Myocardial Contraction; Papillary Muscles; Plants, Medicinal; Plants, Toxic

The prostaglandins A1, E1, A2, E2 and F2a were comparatively studied for their antiarrhythmic action using the model of strophanthin arrhythmia of narcotized cats. Infusions of prostaglandins A1, E2 and F2a in doses of 1-5 mug/kg/min for 5 min improved the arrhythmias in 63%, 83% and 81% of the animals, respectively, whereas prostaglandin A2 was effective in 44%, and prostaglandin E1 in only 10% of the cats. Prostaglandins A1 and E2 transiently established a sinus rhythm in 54 and 50%, and prostaglandin F2a in 18% of the animals. The injection of 12 mu9/kg prostaglandin F2a brought about improvement of arrhythmia in 70% of the animals, producing a transient sinus rhythm in 40%. With ajmaline as the standard substance in doses of 0.3 mg/kg/min for 5 min produced an antiarrhythmic effect in 50% of the animals, while injection of 1 mg/kg was effective in 60% of the animals. Effects on the vegetative nervous system are discussed as the possible action mechanism of the prostaglandins.

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Cats; Disease Models, Animal; Female; Male; Prostaglandins; Prostaglandins A; Prostaglandins E; Prostaglandins F; Strophanthins

Topics: Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Barium; Blood Pressure; Cats; Dogs; Ethylenediamines; Hemodynamics; In Vitro Techniques; Propranolol; Quinidine; Rabbits; Rats; Strophanthins; Time Factors

Topics: Adolescent; Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug Evaluation; Female; Humans; Male; Middle Aged; Quaternary Ammonium Compounds; Tablets

Having briefly touched upon the problem of terminology and classification of arrhythmias the authors consider the diagnosis and clinical evaluation of some disorders, including the extrasystole (the significance of the extrasystolic interval), ectopic arrhythmias from the region of the atrio-ventricular junction (with simultaneous consistent or transent disruption of the intraventricular conduction), isolated atrial tachycardia, some variants of auricular fibrillation, flutter paroxysms, paroxysms of ventricular tachycardia, with continued auricular fibrillation in particular, and also the earlier described electrocardiographic phenomenon tentatively interpreted as sinistroatrial fibrillation with dextraatrial tachycardia, as well as major types of disrupted condution. The authors give a brief exposure of their views as to the principles of the treatment. Emphasis is placed on the importance of a comprehensive clinical approach to the diagnostic matters and to the evaluation of arrhythmias, as well as to the fundamental need to define more precisely the pathogenesis of the disturbed rhythm in a concrete patient so as to adopt an effective treatment.

Topics: Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Cardiac Glycosides; Electric Countershock; Electrocardiography; Humans; Lidocaine; Pacemaker, Artificial; Procainamide; Propranolol; Quinidine; Reserpine; Tachycardia, Paroxysmal

1. In the isolated left atrium of the guinea pig ajmaline and di-monochloracetylajmaline (DCAA) show almost the same activity concerning prolongation of the functional refractory period. 2. In contrast to this N-propylajmaline (NPA) is much more effective than ajmaline. 3. NPA as compared to ajmaline and DCAA, however, shows a considerably smaller difference between the concentrations prolonging refractory period (I) and those decreasing contractility (II) in the guinea pig atrium (EC25). The quotient from I and II is 0.4 with NPA, 1.2 with ajmaline and 1.6 with DCAA. 4. Differences in efficacy similar to those observed in the guinea pig atrium are also found in experimental cardiac arrhythmias in the intact animal. NPA is much more effective than ajmaline regarding inhibition of extrasystoles, ventricular tachycardia and ventricular flutter due to aconitine infusion in the rat. In this experimental model DCAA shows slightly less activity than ajmaline; this difference is statistically significant.

Topics: Aconitine; Aconitum; Ajmaline; Animals; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Electrocardiography; Guinea Pigs; Heart; Heart Atria; Heart Rate; In Vitro Techniques; Male; Myocardial Contraction; Rats; Tachycardia; Ventricular Fibrillation

For the practicing physician the medicamentous treatment of the patients with infarction is the main problem of the secondary prevention in the prehospital phase as well as in the after-treatment. In these cases in the acute phase not the myocardial insufficiency is in the centre of the out-patient care, but the therapy of the disturbances of cardiac rhythm, which mainly cause the high lethality in the early phase. Therefore, uncomplicated infarctions, in whch care must be taken only for a sedation of sympathico-adrenergic reactions and a volume reduction of the heart, should be differed from complicated cases. However, an immediate transport to the hospital must be guaranteed. If there appear a contraction insufficiency of the left ventricle or threatening disturbances of the rhythm, additionally glycosides and saluretics must be administered as well as an aimed antiarrhythmic therapy must be initiated. The necessary medicamentous measures are described dependent upon the diagnosis of brady- and tachycardiac disturbances of the rhythm. The author enters briefly the problems of volume substitution, treatment of acidosis as well as the administration of beta-sympathicolytics and gluco-corticoids. - In the after-treatment of infarctions anticoagulants are the only medicaments to be prescribed, when findings completely without complications are present. If, however, there are signs of activity of the coronary heart disease in the post-infarction phase, a basic therapy with a glycoside and anticoagulants as well as an individually to be varied additive therapy with nitro-preparations, beta-sympathicolytics, saluretics, anti-hypertensive agents and antiarrhythmic agents are necessary.

Topics: Acidosis; Adrenergic beta-Antagonists; Aftercare; Ajmaline; Ambulatory Care; Anticoagulants; Arrhythmias, Cardiac; Atropine; Cardiac Complexes, Premature; Cardiac Glycosides; Glucocorticoids; Heart Block; Heart Failure; Hospitalization; Humans; Lidocaine; Meperidine; Metaproterenol; Morphine; Myocardial Infarction; Nitroglycerin; Tachycardia

Topics: Ajmaline; Angina Pectoris; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Heart Conduction System; Heart Ventricles; Humans; Lidocaine; Myocardial Infarction; Procainamide; Quinidine

The paper summarizes the experience gained in treating 830 patients with various cardiac rhythm disorders by employing new antirhythmic agents (propranolol, practolol, pindolol, alprenolol, oxyprenolol, benzoral, verapamil, lidocaine, imaline, sparteine, pulsonorma, disopyramide and quinidine durules). Comparative data on the efficacy of these agents are presented and indications and counterindications for their use are discussed.

Topics: Administration, Oral; Adrenergic beta-Antagonists; Ajmaline; Alprenolol; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Barbiturates; Drug Combinations; Drug Evaluation; Humans; Injections, Intramuscular; Injections, Intravenous; Lidocaine; Pindolol; Practolol; Propranolol; Sparteine; Verapamil

Topics: Adrenergic beta-Antagonists; Ajmaline; Arrhythmias, Cardiac; Atropine; Drug Therapy, Combination; Humans; Hydrochlorothiazide; Inosine; Isoproterenol; Quinidine

Topics: Adrenergic beta-Agonists; Adrenergic beta-Antagonists; Ajmaline; Arrhythmias, Cardiac; Autonomic Nervous System; Bretylium Compounds; Humans; Lidocaine; Membrane Potentials; Parasympatholytics; Parasympathomimetics; Phenytoin; Procainamide; Quinidine; Verapamil

Topics: Adolescent; Ajmaline; Anesthetics, Local; Aniline Compounds; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Diethylamines; Drug Synergism; Heart Arrest; Humans; Indenes; Male; Seizures

The antiarrhythmic efficacy of ajmaline has been evaluated in three experimental models of cardiac arrhythmias in the dog. These data have been related to the actions of the compound on several parameters of heart function and compared to results obtained in various clinical arrhythmias. Ajmaline was more effective in arrhythmias of the ectopic focus type than in the circus movement model. These results agreed with the pattern of clinical activity. The compound produced decreases in excitability and conduction and increased the functional refractory period in all heart tissues. These effects were most marked in the atrium. The drug also showed a moderate degree of anticholinergic activity. Both in the dogs and in the clinical cases, the agent showed an important hypotensive effect. In a group of experiments in which transmembrane potentials were recorded, the compound produced in all tissues a decrease in upstroke velocity and amplitude of the action potential; it also increased the duration of the action potential in atrial and ventricular muscle, but it decreased it in Purkinje fibers. The possible mechanism(s) of action of the drug is discussed in terms of the different hypotheses for cardiac arrhythmias.

Topics: Action Potentials; Ajmaline; Animals; Arrhythmias, Cardiac; Barium; Blood Pressure; Dogs; Electrocardiography; Female; Heart; Heart Conduction System; Male; Membrane Potentials; Ouabain; Refractory Period, Electrophysiological; Vagus Nerve

The authors report on four cases of immediate hepatotoxic reaction following diagnostic re-exposure. In checking 27 patients who had received NPAB treatment for the first time, four were found to have a hepatotoxic reaction that developed within 13--20 days after beginning the treatment. In view of the significance of NPAB for the treatment of cardiac rhythm disorders, further such studies are required in order to define the actual risk involved in this procedure.

Topics: Adult; Ajmaline; Antibodies; Arrhythmias, Cardiac; Bilirubin; Chemical and Drug Induced Liver Injury; Cholestasis; Eosinophils; Female; Humans; Kidney Tubules; Liver; Middle Aged; Muscle, Smooth; Thyroid Gland; Transaminases

Experimental studies on BaCl2 induced arrhythmias in unanaesthetized rabbits showed an antiarrhythmic effect of prostaglandins A1, A2, E1, E2 and F2a by infusions of 0,1 to 6,0 mug/kg/min over 3 min. There was a maximum antiarrhythmic effect between 50% and 80%. Ajmaline was similarly effective when given in doses 100-1000 times higher. PGA1 and PGE2 were most effective in this model; the ED50-values of the other PGs were 2-3 times higher. The mode of action of PGs is unknown; the following factors are discussed: the influence on the ionic movements, the negative feedback mechanism on the release of adrenergic transmitter and central nervous effects.

Topics: Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Barium; Disease Models, Animal; Dose-Response Relationship, Drug; Prostaglandins A; Prostaglandins E; Prostaglandins F; Rabbits

Topics: Adolescent; Adult; Aged; Ajmaline; Antazoline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug Combinations; Drug Evaluation; Female; Humans; Imidazoles; Male; Middle Aged; Phenobarbital; Sparteine

Topics: Ajmaline; Arrhythmias, Cardiac; Humans; Procainamide

Topics: Ajmaline; Anti-Arrhythmia Agents; Aprindine; Arrhythmia, Sinus; Arrhythmias, Cardiac; Bradycardia; Humans; Isoproterenol; Lidocaine; Myocardial Infarction; Pacemaker, Artificial; Phenytoin; Procainamide; Propranolol; Quinidine; Tachycardia; Verapamil

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Coronary Disease; Female; Humans; Male; Middle Aged; Rheumatic Heart Disease

Topics: Age Factors; Aged; Ajmaline; Arrhythmias, Cardiac; Arteriosclerosis; Cardiac Complexes, Premature; Coronary Disease; Heart Block; Humans; Wolff-Parkinson-White Syndrome

Topics: Action Potentials; Adrenergic beta-Antagonists; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Calcium; Digitalis Glycosides; Heart; Heart Conduction System; Humans; Pacemaker, Artificial; Procainamide; Quinidine; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Administration, Oral; Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Electrocardiography; Female; Humans; Male; Middle Aged; Quaternary Ammonium Compounds; Tachycardia, Paroxysmal; Tartrates; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

Topics: Aconitum; Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Azepines; Benzoates; Cardiac Complexes, Premature; Dogs; Electrocardiography; Epinephrine; Heart Block; Male; Ouabain; Tachycardia

Topics: Action Potentials; Ajmaline; Animals; Anura; Arrhythmias, Cardiac; Cholinesterase Inhibitors; Heart Conduction System; Hydrogen-Ion Concentration; In Vitro Techniques; Membrane Potentials; Sodium

Topics: Aged; Ajmaline; Aniline Compounds; Arrhythmias, Cardiac; Benzyl Compounds; Bone Marrow Examination; Cell Survival; Chromium Radioisotopes; Clot Retraction; Digoxin; Drug Combinations; Drug Hypersensitivity; Ethylenediamines; Histocytochemistry; Humans; Imidazoles; Male; Megakaryocytes; Phenobarbital; Sparteine; Thrombocytopenia

Topics: Aconitum; Ajmaline; Animals; Arrhythmias, Cardiac; Biological Transport; Calcium Chloride; Cell Membrane Permeability; Disease Models, Animal; Heart; Ion Exchange; Myocardium; Potassium; Prostaglandins; Rats; Sodium

Topics: Acute Disease; Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Blood Pressure; Carbamates; Coronary Disease; Drug Resistance; Electrocardiography; Female; Heart Rate; Heart Ventricles; Humans; Hypertension; Infusions, Parenteral; Lidocaine; Male; Middle Aged; Myocardial Infarction; Phenytoin; Procainamide; Quaternary Ammonium Compounds; Quinidine; Tachycardia

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Coronary Disease; Female; Heart Diseases; Humans; Injections, Intravenous; Male; Middle Aged; Tachycardia

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Digoxin; Dogs; Electrocardiography; Female; Male

Topics: Administration, Oral; Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Lidocaine; Male; Middle Aged; Myocardial Infarction; Procainamide; Propranolol; Quinidine

Topics: Acetylcholine; Ajmaline; Animals; Arrhythmias, Cardiac; Electrocardiography; Heart Block; Heart Conduction System; Injections, Intravenous; Phosphocreatine; Rats

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Disopyramide; Electrophysiology; Heart; Humans; Lidocaine; Procainamide; Quinidine

Topics: Administration, Oral; Aged; Ajmaline; Arrhythmias, Cardiac; Drug Evaluation; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Dogs; Female; Guinea Pigs; Heart; Heart Conduction System; Lethal Dose 50; Male; Mice; Picrotoxin; Rabbits

Topics: Administration, Oral; Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Electrocardiography; Female; Humans; Lidocaine; Male; Middle Aged; Phenytoin; Procainamide; Tachycardia, Paroxysmal; Tartrates

Topics: Adrenergic beta-Antagonists; Ajmaline; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bradycardia; Cardiac Complexes, Premature; Digitalis Glycosides; Humans; Hypnotics and Sedatives; Reserpine; Tachycardia

Topics: Ajmaline; Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Caffeine; Cardiac Complexes, Premature; Digitalis Glycosides; Heart Block; Humans; Lidocaine; Metaproterenol; Phenytoin; Procainamide; Tachycardia; Ventricular Fibrillation; Verapamil

Topics: Adrenergic beta-Antagonists; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atropine; Bradycardia; Humans; Lidocaine; Metaproterenol; Phenytoin; Procainamide; Quinidine; Tachycardia; Verapamil

Topics: Aconitum; Adrenergic beta-Antagonists; Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Blood Pressure; Dogs; Dose-Response Relationship, Drug; Electrocardiography; Female; Heart Rate; Male; Ouabain; Ventricular Fibrillation

Topics: Adrenergic beta-Agonists; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bradycardia; Digitalis; Electrocardiography; Heart; Hemodynamics; Humans; Lidocaine; Phenytoin; Phytotherapy; Plants, Medicinal; Plants, Toxic; Procainamide; Propranolol; Quinidine; Tachycardia

Topics: Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Glucagon; Heart Block; Humans; Pacemaker, Artificial; Pindolol

Topics: Aconitum; Ajmaline; Animals; Arrhythmias, Cardiac; Barium; Calcium Chloride; Cats; Chlorine; Dose-Response Relationship, Drug; Electrocardiography; Female; Injections, Intravenous; Male; Ouabain; Prostaglandins; Rabbits; Rats

Topics: Administration, Oral; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug Therapy, Combination; Electrocardiography; Heart Diseases; Humans; Injections, Intravenous; Lidocaine; Phenytoin; Practolol; Procainamide; Sparteine

Topics: Ajmaline; Anesthesia; Arrhythmias, Cardiac; Humans; Practolol; Propranolol

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Female; Humans; Injections, Intravenous; Male; Middle Aged; Procainamide; Propranolol

Topics: Aconitum; Adult; Aged; Ajmaline; Animals; Arrhythmias, Cardiac; Calcium Chloride; Chlorine; Electrocardiography; Female; Guinea Pigs; Heart; Humans; Male; Middle Aged; Ouabain; Rats

Topics: Ajmaline; Animals; Arachidonic Acids; Arrhythmias, Cardiac; Barium; Cats; Chlorides; Drug Evaluation, Preclinical; Linoleic Acids; Ouabain; Rabbits

Topics: Aconitum; Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bretylium Compounds; Guinea Pigs; Lidocaine; Phenytoin; Procainamide; Propranolol; Quinidine; Strophanthins; Verapamil

Topics: Ajmaline; Apgar Score; Arrhythmias, Cardiac; Cesarean Section; Digoxin; Electrocardiography; Extraction, Obstetrical; Female; Fetus; Heart Block; Humans; Infant; Infant, Newborn; Lanatosides; Pregnancy; Prenatal Diagnosis; Tachycardia; Tachycardia, Paroxysmal; Ventricular Fibrillation; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Aconitum; Administration, Oral; Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cats; Cell Membrane Permeability; Depression, Chemical; Dogs; Drug Antagonism; Drug Evaluation, Preclinical; Drug Synergism; Electrocardiography; Heart Conduction System; Heart Rate; Male; Methods; Rats; Sparteine; Tartrates

Topics: Ajmaline; Amiodarone; Arrhythmias, Cardiac; Digoxin; Disopyramide; Humans; Procainamide; Propranolol

Topics: Administration, Oral; Aged; Ajmaline; Arrhythmia, Sinus; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Female; Humans; Male; Middle Aged; Tachycardia, Paroxysmal; Tartrates

Topics: Acetanilides; Adrenergic beta-Antagonists; Ajmaline; Amino Alcohols; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bretylium Compounds; Digitalis Glycosides; Electric Countershock; Humans; Lidocaine; Phenytoin; Propranolol; Propylamines; Pyridines; Quinidine; Tachycardia, Paroxysmal; Ventricular Fibrillation

Topics: Adrenergic beta-Antagonists; Ajmaline; Arrhythmias, Cardiac; Hemodynamics; Humans; Isoproterenol; Myocardial Infarction; Phenytoin; Procainamide; Quinidine

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bretylium Compounds; Drug Synergism; Electrocardiography; Heart Arrest; Heart Ventricles; Humans; Hypotension; Lidocaine; Phenytoin; Propranolol; Tosyl Compounds

Topics: Administration, Oral; Adolescent; Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Child; Female; Humans; Injections, Intravenous; Male; Middle Aged

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Child, Preschool; Electrocardiography; Humans; Hypotension; Lidocaine; Male; Metaproterenol; Muscle Cramp; Paralysis; Phenytoin; Propranolol; Quinidine; Reserpine; Vertigo

Topics: Administration, Oral; Ajmaline; Arrhythmias, Cardiac; Coronary Disease; Dose-Response Relationship, Drug; Electric Stimulation; Electrocardiography; Female; Follow-Up Studies; Humans; Injections, Intravenous; Male; Models, Biological; Monitoring, Physiologic; Pacemaker, Artificial; Pulmonary Embolism; Recurrence; Tartrates; Time Factors

Topics: Acute Disease; Ajmaline; Arrhythmias, Cardiac; Coronary Disease; Electrocardiography; Humans; Male; Middle Aged

Topics: Ajmaline; Arrhythmias, Cardiac; Drug Tolerance; Hemodynamics; Humans; Lidocaine; Myocardial Infarction; Phytotherapy; Plants, Medicinal; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Electric Countershock; Electrocardiography; Heart Massage; Humans; Infant; Male; Metaproterenol; Plants, Medicinal; Poisoning; Rauwolfia; Sodium; Water-Electrolyte Balance

Topics: Adolescent; Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Rauwolfia

Topics: Ajmaline; Amino Alcohols; Animals; Arrhythmias, Cardiac; Biological Transport; Blood Pressure; Cats; Dopamine; Drug Combinations; Electrocardiography; Heart Rate; Injections, Intravenous; Metaproterenol; Plants, Medicinal; Poisoning; Propylamines; Rauwolfia; Receptors, Adrenergic; Respiration, Artificial; Resuscitation

Topics: Action Potentials; Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cattle; Guinea Pigs; Heart Conduction System; Membrane Potentials; Papillary Muscles; Quinidine; Sodium

Topics: Aconitum; Ajmaline; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Capillary Resistance; Cardiac Output; Cardiac Volume; Ethers; Ethylamines; Glycerol; Heart Rate; Lidocaine; Male; Phenytoin; Procainamide; Propranolol; Quinidine; Rats; Respiration, Artificial; Sparteine

Topics: Adrenergic beta-Antagonists; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bradycardia; Digitalis Glycosides; Humans; Phenytoin; Procainamide; Quinidine; Sympatholytics; Tachycardia

Topics: Adrenergic beta-Antagonists; Ajmaline; Analgesics; Arrhythmias, Cardiac; Bradycardia; Child; Child, Preschool; Digitalis Glycosides; Electric Countershock; Electrocardiography; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Metaproterenol; Pacemaker, Artificial; Sparteine; Tachycardia; Tachycardia, Paroxysmal

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Quinidine; Rauwolfia

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Humans; Phytotherapy; Plants, Medicinal; Rauwolfia

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Digoxin; Electric Countershock; Female; Glucagon; Heart Failure; Humans; Lanatosides; Middle Aged; Mitral Valve Insufficiency; Phenytoin; Phytotherapy; Plants, Medicinal; Pulmonary Edema; Quinidine; Rauwolfia; Water-Electrolyte Balance

Topics: Ajmaline; Arrhythmias, Cardiac; Electric Countershock; Humans; Isoproterenol; Metaproterenol; Pacemaker, Artificial

Topics: Aged; Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Female; Heart Block; Humans; Lidocaine; Male; Middle Aged; Myocardial Infarction; Phytotherapy; Plants, Medicinal; Procainamide; Quinidine; Rauwolfia

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Rauwolfia

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Digitoxin; Digoxin; Humans; Lidocaine; Metaproterenol; Middle Aged; Phenytoin; Procainamide; Quinidine; Reserpine; Verapamil

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Electric Countershock; Female; Humans; Lidocaine; Male; Middle Aged; Myocardial Infarction; Pacemaker, Artificial; Procainamide; Ventricular Fibrillation

Topics: Ajmaline; Animals; Arrhythmias, Cardiac; Blood Pressure; Coronary Disease; Coronary Vessels; Dogs; Electrocardiography; Heart Conduction System; Ligation; Magnesium Sulfate; Plants, Medicinal; Postoperative Complications; Rauwolfia; Ventricular Fibrillation

Topics: Adult; Ajmaline; Arrhythmias, Cardiac; Bradycardia; Electrocardiography; Humans; Male; Middle Aged; Ventricular Fibrillation

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Heart Conduction System; Humans; Rauwolfia

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Aspartate Aminotransferases; Blood Chemical Analysis; Child; Chlorides; Creatine Kinase; Electrocardiography; Glucose; Humans; Infusions, Parenteral; Physiology; Potassium; Rauwolfia; Toxicology

Topics: Ajmaline; Arrhythmias, Cardiac; Arteriosclerosis; Atrial Fibrillation; Cardiac Complexes, Premature; Electrocardiography; Humans; Injections, Intravenous; Quinidine; Rauwolfia; Toxicology

Topics: Adolescent; Ajmaline; Arrhythmias, Cardiac; Biomedical Research; Cardiovascular Agents; Dihydroergotoxine; Drug Therapy; Electrocardiography; Ergot Alkaloids; Humans; Neurocirculatory Asthenia; Rauwolfia

Topics: Ajmaline; Alkaloids; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Guinea Pigs; Hypnotics and Sedatives; Pharmacology; Rats; Rauwolfia; Research

Topics: Ajmaline; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Drug Therapy; Emergency Treatment; Humans; Rauwolfia; Tachycardia; Tachycardia, Paroxysmal

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Electrocardiography; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Catheterization; Cardiac Complexes, Premature; Cardiac Conduction System Disease; Digitalis Glycosides; Emergency Treatment; Heart Conduction System; Humans; Rauwolfia; Tachycardia

Topics: Ajmaline; Arrhythmias, Cardiac; Electrocardiography; Guinea Pigs; Humans; Pharmacology; Rabbits; Rauwolfia; Research; Toxicology

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Biomedical Research; Rauwolfia; Toxicology

Topics: Ajmaline; Anemia; Anti-Arrhythmia Agents; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Heart Failure; Humans; Hypertension; Hyperthyroidism; Rauwolfia; Tachycardia

Topics: Ajmaline; Arrhythmias, Cardiac; Biological Phenomena; Cardiology; Humans; Physiological Phenomena

Topics: Ajmaline; Alkaloids; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiology; Heart Diseases; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Humans; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Heart Conduction System; Hypnotics and Sedatives; Rauwolfia

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Humans; Hypnotics and Sedatives; Injections, Intravenous; Rauwolfia

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiovascular Agents; Hypnotics and Sedatives; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Hypnotics and Sedatives; Rauwolfia

Topics: Ajmaline; Alkaloids; Animals; Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Dogs; Heart Conduction System; Rauwolfia

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Hypnotics and Sedatives; Rauwolfia

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Heart Conduction System; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Cardiac Catheterization; Heart Diseases; Humans; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atropa belladonna; Coronary Artery Disease; Coronary Disease; Nitrites; Rauwolfia

Topics: Ajmaline; Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Complexes, Premature; Cardiac Conduction System Disease; Heart Conduction System; Humans

Topics: Ajmaline; Alkaloids; Arrhythmias, Cardiac; Hypnotics and Sedatives; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Ajmaline; Anti-Arrhythmia Agents; Antihypertensive Agents; Arrhythmias, Cardiac; Humans; Secologanin Tryptamine Alkaloids