ajmaline and Coronary-Disease

The aim of this study was to determine whether an antiarrhythmic, Ajmaline, could have proarrhythmic effects on the atrium and to compare the results with those of other antiarrhythmic drugs. A total of 1950 patients without cardiac failure or recent (less than 6 weeks) myocardial infarction were given 1 mg/kg of Ajmaline intravenously during electrophysiological investigation. A proarrhythmic effect was defined as the occurrence of supraventricular tachycardia (SVT) in a patient without this arrhythmia before the test or the facilitation of its induction. Fifty five patients developed SVT (mainly atrial tachyarrhythmias: 48 cases, and some junctional tachycardia: 7 cases) which occurred spontaneously in 22 patients and during fixed atrial pacing in 33 patients. Fifteen patients developed ventricular tachycardia (VT). The predisposing factors for the development of SVT were: a previous history suggesting spontaneous SVT (28 patients; 51 p. 100); sinoatrial block (14 patients--the only abnormality in 10 cases). Seventeen patients had none of these factors but 8 had known cardiac pathology and the other 9 were relatively elderly patients (79 years). Twelve of the patients developing VT had known cardiac disease, bundle branch block in 12 cases and previous VT in 6 cases. In conclusion, proarrhythmic effects of Ajmaline are infrequent if its contraindications are respected, but they do exist at both atrial (2.8 p. 100) and ventricular levels (0.8 p. 100): the risk factors are comparable: previous spontaneous arrhythmias or ECG changes (SA block at the atrial and bundle branch block at the ventricular level).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ajmaline; Anti-Arrhythmia Agents; Coronary Disease; Electric Stimulation; Electrocardiography; Female; Heart Atria; Humans; Male; Middle Aged; Myocardial Infarction; Retrospective Studies; Risk Factors; Tachycardia, Supraventricular

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

The electrophysiological and haemodynamic effects of lidocaine (100 mg) and ajmaline (50 mg) were evaluated while attempting to interrupt sustained ventricular tachycardia. The study was performed as a prospective, non-blinded, randomized investigation in 61 patients. Lidocaine terminated ventricular tachycardia in four of 31 patients, ajmaline in 19 of 30 patients (P less than 0.001). QRS and RR intervals during ventricular tachycardia were prolonged by ajmaline from 164 +/- 28 ms to 214 +/- 49 ms and from 371 +/- 86 ms to 479 +/- 137 ms (P less than 0.001), respectively; lidocaine did not influence these parameters. The duration of the return cycles after termination of ventricular tachycardia did not differ between the two groups. Lidocaine did not change cardiac output during ventricular tachycardia whereas cardiac output increased significantly under ajmaline from 3.5 +/- 1.21.min-1 to 5.5 +/- 1.91.min-1 (P less than 0.001). It is concluded that anti-arrhythmic agents such as ajmaline, which slow conduction velocity and prolong refractoriness, are more effective than lidocaine in the medical treatment of haemodynamically stable, sustained ventricular tachycardia.

Topics: Ajmaline; Cardiac Output; Cardiac Pacing, Artificial; Cardiomyopathy, Dilated; Coronary Disease; Electrocardiography; Female; Heart Rate; Heart Valve Diseases; Heart Ventricles; Hemodynamics; Humans; Lidocaine; Male; Middle Aged; Tachycardia

The safety, tolerability and haemodynamic effects of oral prajmaline bitartrate were assessed in a double-blind, randomized, placebo-controlled, crossover trial in 21 patients with stable angina pectoris and coronary artery disease. No serious side-effects occurred. Prajmaline bitartrate produced no statistically significant changes in resting heart rate or systolic blood pressure or in work capacity on the treadmill, or in heart rate or systolic blood pressure at maximum exercise compared to placebo values. No new arrhythmias or conduction abnormalities were produced in any patient. We conclude that oral prajmaline bitartrate is well tolerated and can be given safely to patients with coronary artery disease without producing deleterious haemodynamic effects or changes in exercise capacity.

Topics: Administration, Oral; Adult; Aged; Ajmaline; Coronary Disease; Exercise Test; Hemodynamics; Humans; Male; Middle Aged; Prajmaline

Prajmalium bitartrate (Neo-Gilurytmal) was given to 19 patients, who had either runs of ventricular extrasystoles or frequent extrasystoles. The E. C. G. was continuously monitored on magnetic tape. At a dosage of 80 mg/d (20 mg every six hours) a significant reduction in ventricular extrasystoles was demonstrated on 20 separate occasions. After two hours extrasystoles decreased to 63% of the initial level. After six hours practically the full effect of the drug had been reached; the reduction in extrasystoles stabilized after 12 hours at an average of 30% of initial level. Ten hours after the last tablet had been taken the frequency of extrasystoles had risen to 57% of initial level. Comparison with procaine amide (3 g/d) in 14 patients revealed no significant difference between the two drugs. Prajmalium bitartrate was well tolerated, while three patients receiving procaine amide complained of nausea and gastrointestinal symptoms, so that treatment had to be discontinued in two. In one patient, receiving procaine amide by continuous drip, there were reversible joint pains, resembling lupus erythematodes.

Topics: Adult; Aged; Ajmaline; Anti-Arrhythmia Agents; Cardiac Complexes, Premature; Cardiomyopathies; Coronary Disease; Electrocardiography; Heart Ventricles; Humans; Middle Aged; Procainamide; Quaternary Ammonium Compounds; Time Factors

The hemodynamic effect of the intravenous application of ajmaline (50 mg) was studied during persistent ventricular tachycardia. With the onset of ventricular tachycardia an increase of heart rate up to 177 +/- 40 bpm and a simultaneous decrease of cardiac output from 7.1 +/- 2.7 l/min to 3.4 +/- 1.1 l/min (p less than 0.001) could be demonstrated. Ajmaline prolonged the QRS interval and slowed the ventricular tachycardia rate to 133 +/- 28 bpm. Simultaneously, an increase of cardiac output to 5.9 +/- 2.3 l/min (p less than 0.001) could be documented. A significant correlation between the increase of cardiac output and the change of ventricular tachycardia rate was found. A drug-induced termination of ventricular tachycardia by ajmaline was possible in 60% of patients. Intravenous application of ajmaline during persistent ventricular tachycardia leads to a hemodynamic improvement caused by the reduction of the tachycardia rate. This temporary stabilization of the hemodynamic status is important for emergency treatment of ventricular tachycardia.

Topics: Adult; Aged; Ajmaline; Cardiac Output; Cardiomyopathy, Dilated; Coronary Disease; Heart Rate; Humans; Infusions, Intravenous; Middle Aged; Tachycardia

To evaluate cardiodepressive risks of antiarrhythmic treatment with ajmaline, we monitored, in addition to conventional hemodynamic parameters, end systolic pressure-volume relations (ESPVR) to assess potential negative inotropic effects. Twelve patients (CAD without ischemia; EF = 60 +/- 3%) underwent hemodynamic analysis with and without the influence of ajmaline (1 mg/kg, i.v.) both 1) at rest (paced heart rate of 90 bpm) and 2) during tachycardia of 160 bpm. As a result, LV-pump function was found to have diminished moderately: EF by 23% vs 10%, respectively; stroke volume by 10% vs 0%; cardiac work by 5% vs 16%, and dP/dtmax by 14% vs 19%. While preload increased under the influence of ajmaline (LVEDP by 17% vs 30%), the LV-volumes increased (EDV by 18% vs 12%; ESV by 58% vs 21%), afterload remained unchanged. Ajmaline caused the loops of the ESPVR to move rightward and the slope k of the ESPVR to decrease, thus indicating loss of inotropy during the influence of the antiarrhythmic agent. Thus, ajmaline showed a tendency to generate cardiodepressive effects in patients with normal LV-function, and to depress contractility in single cases that clinically had no consequences. The conductance technique proved useful and safe in the assessment of inotropic drug effects by analyzing the ESPVR within the catheterization laboratory routine.

Topics: Aged; Ajmaline; Blood Pressure; Blood Volume; Cardiac Catheterization; Cardiac Output; Cardiac Pacing, Artificial; Coronary Disease; Electrocardiography; Female; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Ventricular Function, Left

An electrophysiologic study has been performed in 7 patients with giant stable inversion of the T waves in the precordial ECG leads and without any organic heart disease. The study was particularly directed to evaluate the specific properties of the conductive system. The main results of the study point out the presence of absolute (prolonged HV interval, delay of ventricular activation time) or relative (RRP of the left bundle branch greater than RRP of the right one) conduction delays already in basic conditions or occurring after ajmaline (1 mg/Kg iv). Moreover, repolarization normalized during repetitive high rate atrial extrastimuli in the beats where ventricular activation time shortened and not during regular pacing. On the other hand, repolarization worsened whenever an impairment of infra or intrahisian conduction occurred. During His bundle pacing an inversion of the T waves preceded a left bundle branch conduction delay. The present data make us to hypothesize that, in these patients with pseudoischemia, a delay of activation of the initial vectors of the QRS in the left side, by amplifying the electrical gradient between the 2 ventricles, can be the underlying mechanism causing the repolarization abnormalities.

Topics: Adult; Ajmaline; Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Coronary Disease; Diagnosis, Differential; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged

To determine whether ajmaline (A) can be safely applied in coronary artery disease (CAD), changes of left ventricular (LV) function after acute ajmaline application were analyzed by pulsed Doppler echocardiography in 10 CAD patients. LV pressures in systole and end-diastole and LVEF remained normal and comparable. Doppler normalized peak filling rate (p less than 0.02), peak early/atrial filling velocity (E/A) ratio (p less than 0.01) and E-deceleration (p less than 0.05) increased. The increase in E/A and in E-deceleration relative to base values was directly correlated (p less than 0.001). PEP increased, LVET remained unchanged. LV diastolic filling is improved after acute application of ajmaline in patients with CAD and normal systolic function; its application may be advised not only for therapy of arrhythmia but also to improve left ventricular diastolic mechanics in these patients.

Topics: Aged; Ajmaline; Coronary Disease; Diastole; Echocardiography; Echocardiography, Doppler; Female; Heart; Heart Ventricles; Humans; Infusions, Intravenous; Male; Middle Aged; Regression Analysis; Systole

When no complete atrioventricular block (CAVB), paroxysmal and spontaneous, is recorded, implanting a pacemaker in patients with chronic bundle branch block (CBB) has an arbitrary aspect which must be reduced as much as possible. In order to determine more precisely the criteria predicting an evolution towards CAVB, we studied the electrocardiographic changes observed in 164 patients with various types of CBB. 110 patients had a right bundle branch block which was isolated (RBB) in 16 cases, associated with a left anterior hemiblock (RBB + LAH) in 74 cases and associated with a left posterior hemiblock (RBB + LPH) in 20 cases; 54 patients had a left bundle branch block with a normal axis in 26 cases (LBB - NA) and with a strongly left axis in 28 cases (LBB - LA). All patients had been fitted with a pacemaker. Patients were followed up for a mean period of 5 years (59.1 +/- 25.3 months), the minimum being 2 years. 49.4 p. 100 of them had experienced one ore serveral syncopes. The basal HV interval, studied in 90.2 p. 100 of the patients, was 60 ms or more in 64.9 p. 100 of those who were explored. An ajmaline test, performed in 60 of the 85 patients whose basal HV was less than 70 ms, demonstrated at least a 100 ms or more prolongation of HV in 41 cases (68.3 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Ajmaline; Bundle-Branch Block; Coronary Disease; Electrocardiography; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Pacemaker, Artificial; Prognosis; Time Factors

A microprocessor-based timer has been developed for routine and research use in cardiac electrophysiologic studies. The cycle length (A-A) and the conduction times through the right atrium (A(HRA)-A(HIS], the AV node (A-H) and the His-Purkinje system (H-V) can be automatically measured beat-to-beat in real-time both during sinus rhythm and during atrial pacing. The design has been refined during three years of use in over 80 clinical studies. A comparison between manual and automatic measurements has been executed for randomly chosen portions of 10 studies. With the manual measurements as reference procedures the sensitivities of the automatic measurements of the A, H and V waves were 0.98, 0.88 and 0.92, respectively, while the specificities were 0.93, 0.92 and 0.93, respectively. For the true positive measurements the correlation coefficients of the intervals were r(A-A) = 0.9998, r(A-H) = 0.987 and r(H-V) = 0.988. The statistical analysis of the differences between manual and automatic readings for the intervals A-A, A-H and H-V yielded mean values of -1 ms, -0.8 ms and 0.6 ms and standard deviations of 3 ms, 4 ms and 4 ms which are smaller than the accuracy of the common manual measurements.

Topics: Ajmaline; Coronary Disease; Electrophysiology; Heart Block; Heart Conduction System; Humans; Microcomputers; Middle Aged; Signal Processing, Computer-Assisted; Time Factors

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 pharmacokinetics and the antiarrhythmic action of intravenous ajmaline were investigated in anaesthetized rats subjected to coronary artery occlusion. Ajmaline (0.125-2 mg kg-1, i.v. given just after occlusion) suppressed arrhythmias in a dose-dependent manner, judged by the reduction of premature ventricular complexes. The incidence of malignant arrhythmias (ventricular tachycardia and fibrillation) was preferentially suppressed at the higher doses of ajmaline (1 and 2 mg kg-1). Coronary occlusion induced a change in pharmacokinetics of ajmaline (2 mg kg-1) and its total body blood clearance was significantly decreased from 56.6 ml min-1 kg-1 in sham-operated rats to 43.1 ml min-1 kg-1 in rats after coronary occlusion. Ajmaline exhibited a significantly increased negative dromotropic action (increased PQ interval) in rats after coronary occlusion compared with that in sham-operated rats. The difference seems to be due to the pharmacokinetic change since the concentration-effect relationship was similar in the two groups of rats. We suggest that the measurement of drug levels is important in the assessment of antiarrhythmic agents.

Topics: Ajmaline; Animals; Anti-Arrhythmia Agents; Coronary Disease; Electrocardiography; Enzymes; Heart Rate; Hemodynamics; Kinetics; Male; Rats; Rats, Inbred Strains

Thirty patients undergoing cardiac catheterisation for coronary artery disease received parenteral ajmaline (15 patients) or prajmaline (15 patients). There were no statistically significant induced changes in left ventricular systolic or end diastolic pressures, indirect left atrial pressure, pulmonary artery mean pressure, cardiac output or left ventricular ejection fraction compared to control values. Intravenous prajmaline bitartrate in 15 patients with angina did not significantly alter work capacity, maximum exercise heart rate or systolic blood pressure compared to control values. Five patients developed transient minor conduction defects ( 2LBBB , 1 RBBB, 2 prolonged PR interval): all five were also receiving long-term treatment with beta blockers and nifedipine.

Topics: Adult; Ajmaline; Angina Pectoris; Blood Pressure; Cardiac Catheterization; Cardiac Output; Coronary Disease; Female; Heart Ventricles; Hemodynamics; Humans; Infusions, Parenteral; Male; Middle Aged; Physical Exertion; Prajmaline

The effects of intravenous administration of several quinidine-like antiarrhythmic drugs (bunaftine, monochloroacetyl ajmaline, lidocaine, mexiletine, disopyramide, aprindine, diphenylhydantoin, procainamide) on left ventricular performance, evaluated by systolic time intervals (STI), were studied in 100 patients with atherosclerotic heart disease. The STI were measured: the pre-ejection period (PEP), the isometric contraction time (ICT), the left ventricular ejection time (LVET), corrected LVET (LVETc), and the PEP/LVET ratio. The degree of impairment of left ventricular performance was maximal after aprindine and disopyramide administration. This was demonstrated by significant increases in the PEP, ICT, and PEP/LVET and by significant decreases in LVET and LVETc, in patients in both III-IV and I-II NYHA classes. Bunaftine, monochloroacetyl ajmaline, and lidocaine induced a less marked impairment of myocardial performance, since the PEP, ICT, and PEP/LVET increases were not significant compared to controls in patients in NYHA class I-II, and since no variation of LVET and LVETc were observed. Mexiletine effects on myocardial performance appear to be intermediate between these groups of drugs. Diphenylhydantoin and procainamide, considered separately because of their effects on heart rate and blood pressure which are not possessed by the other drugs, induced significant increases of PEP in NYHA class III-IV patients. However, the effects of these 2 drugs on myocardial performance may have been underestimated, due to the concomitant hemodynamic effect of these drugs.

Topics: Ajmaline; Anti-Arrhythmia Agents; Aprindine; Blood Pressure; Bunaftine; Coronary Disease; Disopyramide; Heart Rate; Hemodynamics; Humans; Lidocaine; Mexiletine; Middle Aged; Myocardial Contraction; Phenytoin; Procainamide

Topics: Ajmaline; Atenolol; Cardiac Complexes, Premature; Coronary Disease; Double-Blind Method; Female; Heart Ventricles; Humans; Male; Middle Aged; Prajmaline; Propanolamines

Topics: Adult; Aged; Ajmaline; Coronary Disease; Electrocardiography; Female; Heart Block; Heart Diseases; Humans; Male; Middle Aged

Topics: Action Potentials; Adolescent; Adult; Aged; Ajmaline; Bunaftine; Coronary Disease; Diabetes Mellitus; Digoxin; Electrocardiography; Female; Heart; Heart Diseases; Heart Ventricles; Humans; Hypertension; Male; Middle Aged; Ventricular Function

Topics: Ajmaline; Coronary Disease; Electrocardiography; Female; Heart Conduction System; Heart Defects, Congenital; Humans; Male; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

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: 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: Aged; Ajmaline; Coronary Disease; Electrocardiography; Humans; Male; Middle Aged; Necrosis; Wolff-Parkinson-White Syndrome

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