ajmaline and Wolff-Parkinson-White-Syndrome

A 31-year-old male patient presented with complaints of palpitations, dizziness, and recurrent episodes of syncope. A 12-lead electrocardiogram (ECG) revealed manifest ventricular preexcitation, which suggested Wolff Parkinson White syndrome. In addition, an incomplete right bundle branch block and a 3-mm ST segment elevation ending with inverted T-waves in V2 were consistent with coved-type (type 1) Brugada pattern. An electrophysiological study was performed, and during the mapping, the earliest ventricular activation with the shortest A-V interval was found on the mitral annulus posterolateral site. After successful radiofrequency catheter ablation of the accessory pathway, the Brugada pattern on the ECG changed, which prompted an ajmaline provocation test. A type 1 Brugada ECG pattern occurred following the administration of ajmaline. Considering the probable symptom combinations of these 2 coexisting syndromes and the presence of recurrent episodes of syncope, programmed ventricular stimulation was performed and subsequently, ventricular fibrillation was induced. An implantable cardioverter-defibrillator was implanted soon after.

Topics: Adult; Ajmaline; Animals; Anti-Arrhythmia Agents; Brugada Syndrome; Bundle-Branch Block; Catheter Ablation; Defibrillators, Implantable; Dizziness; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Male; Recurrence; Syncope; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

The Wolff-Parkinson-White syndrome is a current debated clinical issue. Although the anatomical characteristics, polymorphic electrocardiographic features, and electrophysiological mechanisms of arrhythmias and sudden cardiac death are well known, the identification of patients at risk of sudden cardiac death remains challenging. Owing to the lack of effective therapeutic strategies, in the pre-ablation era many studies have been conducted to define the prognostic value of clinical and instrumental tests, and to define the actual risk of sudden cardiac death in patients with ventricular preexcitation. Nowadays, radiofrequency transcatheter ablation of anomalous atrioventricular pathways is a strong therapeutic option for all patients, independent of the risk of sudden cardiac death. However, radiofrequency ablation is associated with serious complications, but many studies confirm an overall good prognosis for most of the patients with electrocardiographic pattern of ventricular preexcitation. The aim of this review is to assess the prognostic value of clinical and instrumental tests in patients with ventricular preexcitation, referring to the latest knowledge.

Topics: Adolescent; Adult; Age Distribution; Ajmaline; Atrioventricular Node; Catheter Ablation; Child; Child, Preschool; Clinical Trials as Topic; Death, Sudden, Cardiac; Electrocardiography; Exercise Test; Feasibility Studies; Female; Heart Function Tests; Humans; Male; Middle Aged; Procainamide; Prognosis; Propafenone; Risk Assessment; Sex Distribution; Wolff-Parkinson-White Syndrome; Young Adult

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Ajmaline; Amiodarone; Anilides; Aprindine; Atrial Fibrillation; Benzofurans; Digitalis Glycosides; Disopyramide; Encainide; Female; Humans; Lidocaine; Male; Middle Aged; Procainamide; Quinidine; Tachycardia; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Atrioventricular Node; Diagnosis, Differential; Electrocardiography; Humans; Lidocaine; Myocardial Infarction; Procainamide; Quinidine; Verapamil; Wolff-Parkinson-White Syndrome

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

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: Age Factors; Ajmaline; Electrocardiography; Humans; Infant; Male; Procainamide; Quinidine; Sex Factors; Tachycardia, Paroxysmal; Whooping Cough; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Atropine; Cardiac Catheterization; Digitalis Glycosides; Electric Stimulation; Electrocardiography; Heart; Heart Atria; Heart Conduction System; Humans; Male; Methods; Pacemaker, Artificial; Procainamide; Propranolol; Quinidine; Tachycardia; Vagus Nerve; Wolff-Parkinson-White Syndrome

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

In a prospective randomized study, we assessed the electrophysiologic effects and the efficacy of ajmaline versus propafenone in patients with accessory pathways (APs). During initiated atrioventricular (AV) reentrant tachycardia or atrial fibrillation (AF), ajmaline (1 mg/kg as bolus followed by infusion of 15 micrograms/kg/min) or propafenone (2 mg/kg, followed by infusion of 30 micrograms/kg/min.) were randomly administered intravenously (i.v.) in 40 patients with APs. AV reentrant tachycardia terminated in 15 of 16 patients (94%) on ajmaline and in 12 of 15 patients (80%, NS) on propafenone. AF ceased in 4 of 4 patients receiving ajmaline and in 3 of 5 patients receiving propafenone (n.s.). During continuous infusion of drugs, AV reentrant tachycardia became noninducible in 10 (50%) patients receiving ajmaline, as compared with 6 (32%) receiving propafenone (NS). Both drugs significantly prolonged the anterograde and retrograde effective refractory periods (ERPs) of the AP. There were no significant differences in changes in electrophysiologic parameters between the two drugs. Ajmaline and propafenone are highly effective and safe in terminating and preventing reinitiation of AV reentrant tachycardia or AF in patients with APs. Both drugs significantly prolonged the anterograde and retrograde ERPs of the APs.

Topics: Accessory Nerve; Adolescent; Adult; Aged; Ajmaline; Atrial Fibrillation; Electrophysiology; Female; Heart; Heart Conduction System; Humans; Infusions, Intravenous; Male; Middle Aged; Propafenone; Prospective Studies; Refractory Period, Electrophysiological; Tachycardia, Atrioventricular Nodal Reentry; Wolff-Parkinson-White Syndrome

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

Echocardiograms of 52 patients with the Wolff-Parkinson-White (WPW) syndrome were investigated. Abnormal patterns of motion were observed in the left ventricular posterior wall (LVPW) and the interventricular septum (IVS). The abnormal LVPW motion was presumably specific for the syndrome and included early onset of the anterior motion which preceded the first heart sound (S1) and a premature peak formation of the anterior displacement which occurred before the second heart sound. The latter was usually followed by a second lower peak. These findings seem to suggest that both contraction and relaxation of LVPW begin earlier than normal due to ventricular pre-excitation initiated at or near the LVPW. The IVS abnormality characteristic of the syndrome was a posterior protrusion, the onset of which preceded S1. Subsequent motion of IVS was either paradoxical or hypokinetic during ejection. These IVS abnormalities were quite similar to those observed in left bundle branch block. The abnormal LVPW motion was observed in all 20 Type A patients and 10 of the 32 Type B patients. The abnormal IVS motion was observed in 10 Type B patients. We feel that echocardiography could be used as an auxiliary noninvasive means of locating the pre-excitation site in patients with WPW.

Topics: Adolescent; Adult; Ajmaline; Child; Clinical Trials as Topic; Echocardiography; Female; Heart Septum; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Cardiac Pacing, Artificial; Diagnosis, Differential; Electrocardiography; Heart Conduction System; Humans; Male; Metaproterenol; Syndrome; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

A case of 52 years old male patient with antero-septal myocardial infarction in the course of type B Wolff-Parkinson-White syndrome has been described. Intravenous administration of 50 mg of ajmaline 2 hours after admission to hospital suppressed the electrocardiographic signs of preexcitation and disclosed previously imperceptible image of acute inferior myocardial infarction. Repeated intravenous ajmaline injection before discharging from the hospital enabled to specify the final localisation of the infarction (antero-septal and inferior), made possible the realization of ecg exercise test and ventricular late potentials analysis (no late potentials were detected). The clinical course of the disease was complicated by the left ventricular failure, which was brought in check without digitalis administration. The outpatient follow-up is carried out after the health resort treatment and the patient is in good conditions 6 months after his discharge from the hospital. There is no such a case found in the available literature.

Topics: Ajmaline; Electroencephalography; Exercise Test; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Electrophysiology; Humans; Wolff-Parkinson-White Syndrome

Pregnancy is related to an increased frequency of arrhythmias in asymptomatic patients with Wolff-Parkinson-White syndrome, which might lead to sudden death. A 40-year-old woman, with Wolff-Parkinson-White syndrome which was not diagnosed until pregnancy, presented in the 34th week with an atrial fibrillation, with high risk criteria for ventricular fibrillation. Intravenous ajmaline was given to convert the tachyarrhythmia to sinus rhythm. We obtained an excellent maternal control with no maternal or fetal adverse effects.

Topics: Adult; Ajmaline; Atrial Fibrillation; Electrocardiography; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Wolff-Parkinson-White Syndrome

A knowledge of electrophysiological parameters of accessory atrioventricular conduction pathways, such as effective refractory time and high conduction capacity in atrial fibrillation, make it possible to detect those patients who are at risk of life-threatening ventricular tachyarrhythmias. One criterion to identify these electrophysiological parameters is persistent pre-excitation after intravenous administration of ajmaline in Wolff-Parkinson-White (WPW) syndrome. Sensitivity and specificity of the ajmaline test in detecting patients at risk of life-threatening ventricular tachyarrhythmias were evaluated in 58 consecutive patients (22 females, 36 males; mean age 40.2 +/- 13 years) with the WPW syndrome. Pre-excitation was blocked after ajmaline in 43 patients (74%), pre-excitation persisting in 15 (26%). In 26 of the 43 patients with blocked pre-excitation the ajmaline test indicated short effective refractory time (< 270 ms) of the accessory pathway, and a high conduction capacity in 19 (minimal pre-excitation R-R interval during atrial fibrillation of < 250 ms). Sensitivity of the ajmaline test in the detection of a short refractory time was 33.3%, specificity 89.4%, while the corresponding values were 40.6% and 92.3% for the detection of accessory pathways with high conduction capacity in atrial fibrillation. These data show that the ajmaline test is not useful for estimating the electrophysiological characteristics of the accessory pathways. It is thus of only subordinate diagnostic value in predicting how much patients with the WPW syndrome are at risk of serious ventricular tachyarrhythmias.

Topics: Adult; Ajmaline; Atrioventricular Node; Catheter Ablation; Electrocardiography; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Reaction Time; Sensitivity and Specificity; Wolff-Parkinson-White Syndrome

In a patient with the Wolff-Parkinson-White syndrome, the existence of dual accessory pathways, both right-sided, was suspected during ajmaline test and confirmed during electrophysiologic study. The first accessory pathway was manifest in sinus rhythm while the second was obscured and revealed during low right atrial pacing. Ajmaline abolished conduction over the first pathway which most probably had a long refractory period allowing manifestation of the second pathway which had a very short refractory period. A longer conduction time over the second accessory pathway was suggested to explain its concealment during sinus rhythm.

Topics: Adult; Ajmaline; Electrophysiology; Female; Heart Conduction System; Humans; Wolff-Parkinson-White Syndrome

The aim of this report is to attempt a definition of functional properties of Kent bundle on the basis of electrophysiologic and electropharmacologic data obtained from 89 cases of Wolff-Parkinson-White syndrome selected among a total number of 114 consecutive cases of WPW syndrome that underwent electrophysiologic intracavitary study. In 36 cases anterograde (ant) and retrograde (retr) effective refractory period (ERP) of accessory pathway were evaluated with premature (atrial and ventricular) stimulation at the same driven cycle length. The ant-ERP was longer than retr-ERP in 28/36 patients, shorter in 5 and equal in 2. This strong discrepancy between ant- and retr- ERP suggests an important role of "impedance mismatch" in the activation of ventricular (or atrial) muscle through an anomalous muscular bundle. In 11 cases an intermittent pattern of ventricular preexcitation was observed; in all these patients an anterograde supernormal conduction through the accessory pathway was observed. This aspect could be related to the activation of ventricular muscle, beyond Kent bundle, in its supernormal phase of excitability, suggesting the critical role played by ventricular activation for the appearance of preexcitation. Isoproterenol, injected in 11 cases (1 among them with intermittent ventricular preexcitation in basal conditions), produced a reduction of ant-ERP in all these cases, in spite of its well known poor effect on refractoriness of myocardial fibers. Ajmaline, injected in 32 patients, was able to block ventricular preexcitation in 81% of the cases, in spite of its poor effect on refractoriness of normal tissues. It is very likely that the disappearance of ventricular preexcitation is in this instance expression of lack of ventricular excitation (distal to Kent bundle) consequent to a drug-induced reduction of membrane responsiveness of ventricular cells. In conclusion, all these aspects strongly suggest that the appearance of ventricular (or atrial) preexcitation could be related to the activation of ventricular (or atrial) muscle distal to Kent bundle, rather than to conduction through the Kent bundle itself.

Topics: Ajmaline; Electrophysiology; Heart Conduction System; Humans; Isoproterenol; Wolff-Parkinson-White Syndrome

Topics: Adolescent; Adult; Aged; Ajmaline; Child; Female; Flecainide; Heart Conduction System; Humans; Infusions, Intravenous; Male; Middle Aged; Regression Analysis; Wolff-Parkinson-White Syndrome

The fitness of patients with Wolff-Parkinson-White syndrome to indulge in sporting activities is a practical cardiology problem. The major risk is sudden death due to atrial fibrillation deteriorating to ventricular fibrillation. This risk is small or even theoretical, but signing a fitness certificate engages the clinician's responsibility. Non invasive complementary examinations are useful. Echocardiography may detect a heart disease that would preclude any sport. Exercise tests explore the behaviour of the accessory pathway and rarely trigger off arrhythmias. Holter recordings mainly investigate disorders of the atrial rhythm. The decision concerning fitness may be based on clinical symptoms. Exercise-induced tachycardia is a classical contra-indication to competitive sports. In patients whose tachycardia is unrelated to exercise, fitness may be discussed according to the results of exercise tests and of the electrophysiological study. A refractory period which would be considered as rather prolonged at rest does not protect against fast ventricular rate during passage to atrial fibrillation. If pre-excitation disappears during the exercise test in an asymptomatic patient, then competitive sports can be authorized without limitations. If not, only surgical excision or fulguration would provide full protection against a potentially dangerous fibrillation. It is concluded that Wolff-Parkinson-White syndrome contra-indicates competitive sports in most cases. Games played outside competitions remain possible in the absence of symptoms or when arrhythmias are well controlled by medical treatment.

Topics: Ajmaline; Electrocardiography; Exercise Test; Humans; Monitoring, Physiologic; Physical Fitness; Sports; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Electrocardiography; Female; Heart Conduction System; Humans; Male; Middle Aged; Neural Conduction; Refractory Period, Electrophysiological; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Exercise Test; Humans; Male; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Electrocardiography; Female; Humans; Male; Vectorcardiography; Verapamil; Wolff-Parkinson-White Syndrome

Ajmaline test (50 mg intravenously over 1 minute) and ergometric exercise test were performed in 24 patients with the Wolff-Parkinson-White syndrome. The effects of both tests on the conduction in the accessory pathway (AP) were correlated with the anterograde effective refractory period (ERP) of the AP. Ajmaline caused transient anterograde block in the AP in 15 patients, 14 with an ERP of more than 250 ms and 1 with an ERP of 250 ms. Ajmaline failed to abolish preexcitation in 9 patients, all with ERP of the AP of 250 ms or less. Exercise testing caused anterograde block in the AP in 5 patients, in 2 during exercise (ERP of 340 and 360 ms) and in the remaining 3 patients during the recovery phase (ERP of 600, 520 and 460 ms). Of the 10 patients with an ERP of 250 ms or less, ajmaline did not abolish preexcitation in 9 and exercise did not abolish it in any of them. Of the 7 patients with an ERP of 330 ms or more, ajmaline abolished preexcitation in 7 and exercise abolished it in 5 patients. Of the 7 patients with ERP of the AP more than 250 ms but less than 330 ms, ajmaline but not exercise abolished preexcitation in all. Thus, ajmaline and exercise testing can detect patients with short and long ERPs of the AP, respectively, and the effects of ajmaline and exercise tests combined may be useful in the noninvasive assessment of various ranges of ERP of the AP.

Topics: Adult; Aged; Ajmaline; Electrocardiography; Electrophysiology; Female; Heart Function Tests; Heart Ventricles; Humans; Male; Middle Aged; Physical Exertion; Wolff-Parkinson-White Syndrome

Anterograde block in the accessory pathway with a short effective refractory period was observed after intravenous (IV) injection of 1 mg/kg of ajmaline in two patients with the Wolff-Parkinson-White syndrome. The possibility of a false-negative response to this test is discussed. Ajmaline is proposed as an emergency drug in the Wolff-Parkinson-White syndrome in the setting of atrial fibrillation with a very high ventricular rate.

Topics: Adult; Aged; Ajmaline; Atrial Fibrillation; Electrocardiography; False Negative Reactions; Heart Block; Humans; Male; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

This study compared the phase images of 12 normal subjects and 14 patients with right ventricular and 5 patients with left ventricular preexcitation. The phase images obtained from equilibrium radionuclide ventriculographies in the left anterior oblique portion with an ECG trigger: Fourier analysis was used to measure the phase and amplitude of the variations. In normal subjects the mean difference in phase was nearly zero: in 12 of the 14 patients with right ventricular preexcitation, right ventricular preceded left ventricular contraction (LV phase - RV phase = + 23 degrees); injection of Ajmaline normalised the ECG and suppressed the premature right ventricular contraction during right ventricular preexcitation (LV phase - RV phase = nearly zero), demonstrating a direct relationship between the abnormal depolarisation and abnormal contraction. In left sided Kent bundles, phase imaging did not seem to show significant premature ventricular contraction under basal conditions. Atrial pacing, which accentuated both left and right electrical preexcitation, increased the difference in ventricular phase. Finally, a satisfactory correlation was observed between the presumed locations of the accessory pathways and the zones of premature right and left ventricular contraction.

Topics: Adult; Aged; Ajmaline; Female; Heart Conduction System; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Wolff-Parkinson-White Syndrome

A 72-year-old man with Wolff-Parkinson-White syndrome and sick sinus syndrome had colon cancer, suggesting that the conduction of the Kent bundle depends on the serum potassium level. Because of severe diarrhea or furosemide administration, the serum potassium level in this patient was sometimes low. When it was less than 3.0 mEq/l delta wave or re-entrant tachycardia via the Kent bundle occurred. These were suppressed by the administration of potassium. On the other hand, when the serum potassium level was normal or high, neither effect was noted, and electrophysiological studies, done when the level was 3.2 mEq/l, showed no evidence of conduction by the accessory pathway. This suggests that conduction through the Kent bundle depends on the serum potassium level.

Topics: Aged; Ajmaline; Combined Modality Therapy; Drug Therapy, Combination; Electrocardiography; Heart Conduction System; Humans; Male; Pacemaker, Artificial; Potassium; Verapamil; Wolff-Parkinson-White Syndrome

Intermittent preexcitation, block in the accessory pathway after intravenous injection of ajmaline or procainamide, and block in the accessory pathway during exercise usually exclude a short antegrade refractory period of an accessory pathway in patients with the Wolff-Parkinson-White syndrome. This report describes three patients with these findings suggestive of a relatively long antegrade effective refractory period of the accessory pathway in whom life-threatening ventricular response occurred during atrial fibrillation. In the first patient with a pattern of intermittent preexcitation, rapid ventricular response with wide QRS was present during atrial fibrillation. In the second patient in whom preexcitation disappeared after intravenous injection of ajmaline or procainamide as well as during exercise testing, atrial pacing showed 1:1 conduction over the accessory pathway at a cycle length of 220 msec and the shortest R-R interval during induced atrial fibrillation was 190 msec. The third patient, with no evidence of preexcitation during sinus rhythm, presented antidromic reciprocating tachycardia and atrial fibrillation with life-threatening ventricular response, the minimal R-R interval being 220 msec. Noninvasive tests in the preexcitation syndrome lack sufficient prognostic sensitivity. The evaluation of ventricular response during induced atrial fibrillation represents the most reliable means of identifying such patients at risk.

Topics: Adult; Aged; Ajmaline; Atrial Fibrillation; Cardiac Pacing, Artificial; Electrocardiography; Female; Heart Conduction System; Heart Ventricles; Humans; Male; Middle Aged; Procainamide; Prognosis; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Diagnosis, Differential; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Vectorcardiography; Wolff-Parkinson-White Syndrome

In Wolff-Parkinson-White (WPW) syndrome, the two most commonly occurring arrhythmias are circus movement tachycardia (CMT) and atrial fibrillation (AF). In 70% of patients with clinically documented CMT in whom the arrhythmia could be initiated by programmed electrical stimulation of the heart, the same CMT could still be initiated after long-term oral amiodarone administration. Spontaneous clinical recurrence of the arrhythmia was, however, observed in only 10% of patients. This finding suggests that the beneficial effect of amiodarone on CMT is primarily based on the prevention of the CMT-initiating premature beat. This may also apply to atrioventricular nodal reentrant tachycardia, in which amiodarone is also extremely effective in preventing relapses. The role of amiodarone in other forms of reentrant, or ectopic, supraventricular tachycardias is less well defined. During AF in WPW syndrome, the ventricular rate is related to the duration of the anterograde refractory period of the accessory pathway. Amiodarone prolongs this value, resulting in the reduction of ventricular rate during AF. Unfortunately, in the presence of a short anterograde refractory period of the accessory pathway, amiodarone results in only a small amount of lengthening of this value. In these patients the beneficial effect of amiodarone may primarily be related to the prevention of episodes of AF. We also found that the effect of oral amiodarone on the duration of the anterograde refractory period of the accessory pathway can (1) be abolished by sympathetic stimulation with isoproterenol and (2) be predicted from the effect of ajmaline or procainamide given intravenously. These observations clearly have practical clinical implications.

Topics: Ajmaline; Amiodarone; Atrial Fibrillation; Benzofurans; Electrophysiology; Heart; Humans; Isoproterenol; Procainamide; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Cardiomyopathy, Hypertrophic; Electrocardiography; Humans; Male; Middle Aged; Wolff-Parkinson-White Syndrome

In patients with the Wolff-Parkinson-White syndrome, intravenous ajmaline (50 mg administered over 3 minutes) or procainamide (10 mg/kg body weight administered over 10 minutes) is helpful in defining the duration of the anterograde effective refractory period of the accessory pathway. In this study the value of the ajmaline-procainamide test to predict the effects on the anterograde effective refractory period of the accessory pathway of long-term oral amiodarone were assessed. Thirty-six patients with the Wolff-Parkinson-White syndrome were studied. Twenty-four (Group A) had a negative result of the ajmaline-procainamide test and a mean duration of the anterograde effective refractory period of the accessory pathway of 237 +/- 24 ms. Twelve (Group B) had a positive result in the ajmaline-procainamide test (disappearance of preexcitation during sinus rhythm after administration of ajmaline and procainamide) and a duration of the anterograde effective refractory period of the accessory pathway of 284 +/- 25 ms (p less than 0.05 versus values in Group A). Amiodarone prolonged the anterograde effective refractory period of the accessory pathway by 53 +/- 35 ms in patients in Group A to 290 +/- 37 ms (p less than 0.001) and by 100 +/- 85 ms in patients in Group B to 384 +/- 94 ms (p less than 0.001). The difference in mean increase between both groups was not significant. In most patients (83%) in Group A amiodarone prolonged the anterograde effective refractory period of the accessory pathway to 260 to 330 ms. However, in most patients (83%) in Group B, amiodarone prolonged the anterograde effective refractory period of the accessory pathway to greater than or equal to 330 ms (p less than 0.01). Thus, an ajmaline-procainamide test is of value in predicting the results of oral amiodarone on the anterograde effective refractory period of the accessory pathway.

Topics: Adolescent; Adult; Ajmaline; Amiodarone; Benzofurans; Electrophysiology; Female; Heart Conduction System; Humans; Male; Middle Aged; Procainamide; Time Factors; Wolff-Parkinson-White Syndrome

Topics: Administration, Oral; Adolescent; Adult; Aged; Ajmaline; Atrial Fibrillation; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Middle Aged; Quinidine; Wolff-Parkinson-White Syndrome

Like ajmaline, procainamide can be used to identify patients with the Wolff-Parkinson-White syndrome who have a short refractory period of the accessory pathway in an anterograde direction. Procainamide given intravenously in a maximal dose of 10 mg/kg body weight over a 5 minute period during sinus rhythm produced complete anterograde block in the accessory pathway in 20 of 39 patients. An electrophysiologic investigation performed 24 to 48 hours later revealed that in 19 of the 20 patients the effective refractory period of the accessory pathway was 270 ms or greater. In 18 of the 19 patients not exhibiting anterograde block in the accessory pathway, the refractory period was less than 270 ms. When ajmaline was compared with procainamide in the same patients, 100 mg of procainamide had approximately the same effect as 10 mg of ajmaline. The use of intravenous procainamide is a reliable and rapid method of identifying patients with the Wolff-Parkinson-White syndrome who may be at risk for circulatory insufficiency or sudden death in case of atrial fibrillation.

Topics: Adolescent; Adult; Aged; Ajmaline; Child; Electrocardiography; Female; Heart Conduction System; Humans; Male; Middle Aged; Myocardial Contraction; Procainamide; Wolff-Parkinson-White Syndrome

Topics: Adrenergic beta-Antagonists; Ajmaline; Amiodarone; Benzofurans; Drug Therapy, Combination; Humans; Quinidine; Tachycardia; Verapamil; Wolff-Parkinson-White Syndrome

Forty-five patients with Wolff-Parkinson-White syndrome (WPW) were reviewed. The preexcitation using Boineau's classification was: right anterior (six patients), left lateral (nine patients), right posterior (15 patients) and left posterior (15 patients). Normal pathway conduction was observed to occur either spontaneously or after administration of ajmaline, procainamide, or by eye-ball pressure. Disappearance of preexcitation was associated with T wave abnormalities in 39 patients (86.6%). The orientation of the T spatial vector (SAT), after suppression of the WPW aspect, varied according to the site of ventricular preexcitation. In eight patients with left lateral ventricular preexcitation (LLVP), the frontal T wave axis was between +70 degrees and +120 degrees (mean +92 degrees) and the horizontal T wave axis was located in the left anterior quadrant. In the five patients with right anterior ventricular preexcitation (RAVP), the frontal axis was between + 40 degrees and - 10 degrees (mean + 26 degrees) and the horizontal axis was in the left posterior quadrant. The 26 cases with right posterior ventricular preexcitation (RPVP) and left posterior ventricular preexcitation (LPVP) had a frontal axis between - 10 degrees and - 70 degrees (mean -39 degrees) and the horizontal T wave axis in the left anterior quadrant. This study suggests that the T wave anomalies observed after suppression of the WPW aspect are in direct relation to the localization of the preexcitation according to Boineau's classification. The analogy between the abnormalities of the T wave and those which are observed after right ventricular pacing (VP) or after disappearance of left bundle branch block (LBBB) is discussed.

Topics: Adolescent; Adult; Aged; Ajmaline; Child; Electrocardiography; Female; Heart Conduction System; Humans; Male; Middle Aged; Procainamide; Reflex, Oculocardiac; Wolff-Parkinson-White Syndrome

Topics: Adolescent; Ajmaline; Diagnosis, Differential; Electrocardiography; Humans; Male; Wolff-Parkinson-White Syndrome

Ajmaline was administered intravenously to six patients with the Wolff-Parkinson-White syndrome for the acute management of paroxysmal atrial flutter (three patients) or fibrillation (three patients) with a fast ventricular response (over the accessory pathway). Ajmaline increased refractoriness in the accessory pathway in all three patients with atrial flutter and stopped the flutter in one. The drug completely abolished preexcitation in two of the three patients with atrial fibrillation, decreasing the means ventricular rate of 240 and 300 beats/min to 110 and 180 beats/min, respectively. In the third patient with atrial fibrillation, ajmaline increased refractoriness over the accessory pathway, decreasing the mean ventricular rate of 300 beats/min to 160 beats/min. In two patients ajmaline was continued as an intravenous maintenance infusion until sinus rhythm was restored. It is concluded that ajmaline is an effective drug for the acute management of atrial flutter or fibrillation with a fast ventricular response in patients with the Wolff-Parkinson-White syndrome.

Topics: Adult; Aged; Ajmaline; Atrial Fibrillation; Atrial Flutter; Electrocardiography; Female; Heart Rate; Humans; Injections, Intravenous; Male; Middle Aged; Wolff-Parkinson-White Syndrome

Ajmaline given intravenously produced complete anterograde block in the accessory pathway of 32 of 59 patients with the Wolff-Parkinson-White syndrome. An electrophysiologic investigation performed 1 day later revealed that failure of ajmaline to produce complete anterograde block in the accessory pathway corresponded to a short refractory period of this pathway (less than 270 ms). The use of ajmaline intravenously is advanced as a reliable and rapid procedure for identifying those patients with the Wolff-Parkinson-White syndrome who have a short refractory period of the accessory pathway and are possible at risk of circulatory insufficiency or sudden death if atrial fibrillation supervenes.

Topics: Adolescent; Adult; Ajmaline; Atrial Fibrillation; Child; Electrophysiology; Female; Humans; Male; Middle Aged; Time Factors; Wolff-Parkinson-White Syndrome

Twenty-one patients were studied in whom ventricular preexcitation (VP) had been recorded in the past and had later disappeared, indicating antegrade block in the accessory pathway (AP), either spontaneously (10 patients) or under the effect of chronic treatment with amiodarone (11 patients). VP reappeared in nine cases during vagal stimulation, and in five cases during an i.v. isoproterenol infusion. Retrograde conduction over the AP was studied in four of the remaining seven patients and was found to be present in three and absent in one. Although these patients differ from the ordinary patient with concealed AP in that antegrade preexcitation had been demonstrated in the past, this study suggests that concealed VP may result from the following mechanisms: 1) an extremely prolonged refractory period in the AP, causing a rate-dependent VP that can be identified during vagal stimulation; 2) a rate-independent depression of antegrade conduction that can be reversed by isoproterenol; 3) a depression of conduction that is apparently no longer reversible. Only in the latter case is a study of retrograde conduction needed to identify the concealed VP. These three mechanisms are likely to be a natural sequence of events leading to complete antegrade block in the AP.

Topics: Adult; Ajmaline; Amiodarone; Female; Heart Conduction System; Heart Rate; Humans; Isoproterenol; Male; Middle Aged; Vagus Nerve; Wolff-Parkinson-White Syndrome

Six patients including three females with WPW syndrome (three with type A and three with type B) presenting with recurrent paroxysmal tachyarrhythmia were subject to electrophysiological studies. Apart from basal parameters, rapid atrial and ventricular pacing was done which confirmed electrophysiological characteristics of bundle of Kent operation. A single intravenous bolus of ajmaline 50 mg. was effective in blocking the bundle of Kent in all patients within 30 seconds of injection with the effect persisting for 15 minutes in one and from 25 to 60 minutes in the others. The most dramatic effect was prolongation of the HV interval with normalization of QRS complex with a marginal effect on the AH interval. The drug was also effective in breaking narrow QRS tachycardia in two patients and broad QRS tachycardia in one patient. Long-term oral therapy with ajmaline has proved effective in preventing recurrent tachyarrhythmias. We conclude that ajmaline is specifically effective and safe in the treatment of the WPW syndrome.

Topics: Adult; Ajmaline; Bundle of His; Electrocardiography; Electrophysiology; Female; Heart Block; Heart Conduction System; Humans; Male; Middle Aged; Tachycardia; Time Factors; Wolff-Parkinson-White Syndrome

The effect of procainamide, quinidine, ajmaline and amiodarone on the effective refractory period of the accessory pathway in the (A-V) anterograde and retrograde directions was studied in relation to the length of this period before drug administration. All patients had the Wolff-Parkinson-White syndrome and were studied with intracavitary recordings and programmed electrical stimulation of the heart using identical basic cycle lengths and test stimulus intervals before and after drug administration. The patients were separated into two groups, those in whom the effective refractory period of the accessory pathway was 270 ms or greater (Group 1) and those in whom it was less than 270 (Group 2). In the anterograde direction the magnitude of increase in the length of the effective refractory period of the accessory pathway after drug administration was related to its initial length. Only modest lengthening of this period could be accomplished in patients with an initially short period. In evaluating the effect of drugs in patients with the Wolff-Parkinson-White syndrome, the role of the initial length of the effective refractory period of the accessory pathway should be considered.

Topics: Accessory Nerve; Adolescent; Adult; Ajmaline; Amiodarone; Child; Female; Heart Block; Humans; Male; Middle Aged; Neural Conduction; Procainamide; Quinidine; Refractory Period, Electrophysiological; Time Factors; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Anti-Arrhythmia Agents; Female; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Echocardiography; Electrocardiography; Humans; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Dextrocardia; Electrocardiography; Heart Conduction System; Humans; Injections, Intravenous; Male; Wolff-Parkinson-White Syndrome

Three patients with reentrant tachycardia are described who had an accessory pathway with a very long conduction time that was incorporated in the tachycardia circuit. The accessory pathway was able to conduct in one direction only, in retrograde manner in two patients and in anteriograde manner in the remaining patient. Evidence is presented that reveals that in the first two patients the accessory pathway was septally located, had completely bypassed the normal atrioventricular (A-V) conduction system, had properties of decremental conduction, and had an atrial exit close to the coronary sinus and a ventricular exit relatively far from the atrioventricular A-V ring. In the third patient, who manifested wide QRS complex during tachycardia, the ventricular end of the accessory pathway seemed to be located close to the right ventricular apex. The atrial end of the pathway could not be localized exactly.

Topics: Adult; Ajmaline; Atropine; Bundle-Branch Block; Cardiac Pacing, Artificial; Child; Electrocardiography; Female; Heart Conduction System; Humans; Male; Physical Exertion; Tachycardia; Tachycardia, Paroxysmal; Time Factors; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Electrocardiography; Female; Humans; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Escape beats probably arising from the anomalous bundle were documented in 2 patients with the Wolff-Parkinson-White (WPW) syndrome. A third patient, in whom complete AV block developed both in the anomalous bundle and the normal pathway, showed the occurrence of escape beats (an escape-bigeminy pattern), as well as a regular idioventricular rhythm arising from the anomalous bundle. Phase 4 block in the anomalous bundle occurred in 7 other patients, in 4 of them spontaneously and in 3 only after the administration of ajmaline or amiodarone. Only 4 of 14 fully investigated patients (out of a total number of 23) showed absence of both escape beats and phase 4 block. The escape beats were considered as direct evidence, and the phase 4 block as indirect evidence, for the existence of automaticity in the anomalous bundle. Such evidence supports the view that the anomalous bundle, like the His bundle-branch system, may be composed of specialised tissue endowed with the property of automaticity.

Topics: Adolescent; Adult; Ajmaline; Amiodarone; Electrocardiography; Female; Heart Conduction System; Humans; Male; Middle Aged; Sinoatrial Node; Wolff-Parkinson-White Syndrome

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

Topics: Adult; Aged; Ajmaline; Bundle-Branch Block; Digitalis Glycosides; Electrocardiography; Heart Conduction System; Humans; Male; Middle Aged; Propranolol; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Diagnosis, Differential; Female; Humans; Middle Aged; Myocardial Infarction; Vectorcardiography; Wolff-Parkinson-White Syndrome

Phase 4 or phase 3 block or both occurred in the His bundle branch system of 11 patients with intermittent bundle branch block and in the anomalous bundle of 6 of 46 patients with the Wolff-Parkinson-White syndrome (13%). Administration of a single dose of ajmaline (50 mg intravenously) in these patients caused a similar response: expansion of the range of phase 3 and phase 4 block at the expense of the intermediate normal conduction range and total interruption of conduction in the affected fascicle when the effect of the drug was maximal. The great similarity in physiologic behavior and pharmacologic response in these groups of patients suggests that the anomalous bundle was probably diseased or abnormal in the six patients with Wolff-Parkinson-White conduction. In addition, ajmaline caused the first appearance of phase 4 or phase 3 block, or both, but not total interruption of conduction in 26 of the 46 patients with Wolff-Parkinson-White conduction (56.5%). Ajmaline does not cause fascicular block in normal subjects; thus this finding suggests either that the anomalous bundle is diseased or that the safety margin for conduction in the anomalous bundle is much narrower than in the bundle branch system. The conduction-depressing action of ajmaline may be greater at relatively rapid or relatively slow rates of stimulation, and smaller or absent at intermediate rates.

Topics: Ajmaline; Bundle-Branch Block; Depression, Chemical; Heart Conduction System; Humans; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Wolff-Parkinson-White Syndrome

The rate association of a "type A" W.P.W. syndrome with a left bundle branch block gives a characteristic electrocardiographic picture:--the left bundle branch block is partially masked, the delay in the basial region of the left ventricle being in part cancelled by pre-excitation--the features of the W.P.W. syndrome are also modified, since the ventricular axis is corrected by the left bundle branch block. The electrocardiographic tracings taken during the various tachycardias and during treatment for arrhythmia, together with the intra-cavitary recordings allow a precise diagnosis to be made. In this case, vectocardiography was particularly useful as it gave a clear demonstration of the median delay of the ventricular loop, the only pathognomic feature of left bundle branch block, during a period when the left bundle of Kent was functioning.

Topics: Aged; Ajmaline; Bundle-Branch Block; Electrocardiography; Electrophysiology; Female; Humans; Vectorcardiography; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Electrocardiography; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Adolescent; Adult; Ajmaline; Child; Child, Preschool; Diagnosis, Differential; Electrocardiography; Humans; Wolff-Parkinson-White Syndrome

Electrical stimulation of the heart, using the single test stimulus method, gives the opportunity to study the mechanisms of tachycardias and the effect of drugs on these mechanisms directly in the heart of the patient with the WPW syndrome. Using these methods the effect of digitalis, procainamide, quinidine, ajmaline, lidocaine, propranolol and verapamil has been studied. Understanding of the mechanisms responsible for initiation and maintenance of tachycardias and the way in which they can be influenced by drugs should be of help in the treatment of the symptomatic patient with the WPW syndrome.

Topics: Ajmaline; Digitalis Glycosides; Electric Stimulation; Humans; Lidocaine; Procainamide; Propranolol; Quinidine; Verapamil; Wolff-Parkinson-White Syndrome

A case of idiopathic hypertrophic subaortic stenosis (IHSS) associated with Wolff-Parkinson-White (WPW) syndrome is studied. On three occasions preexcitation was suppressed with an intravenous injection of ajmaline. The left ventricular outflow tract obstruction (LVOTO) was analyzed; when WPW syndrome activation disappeared, the obstruction decreased. The ventricular depolarization pathway is noteworthy as a factor in the severity of LVOTO in IHSS.

Topics: Ajmaline; Cardiac Catheterization; Cardiomyopathy, Hypertrophic; Electrocardiography; Heart; Humans; Male; Middle Aged; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Humans; Methods; Wolff-Parkinson-White Syndrome

Conduction in the Kent bundle was studied in 17 patients with WPW syndrome, before and after administration of ajmaline and amiodarone. Before drug administration, only one patient showed phase-3 block and only one other showed phase-4 block. After administration of ajmaline to 11 patients and amiodarone to 16 patients (each patient received at least one of the drugs and the two drugs were given independently to 10 patients), the occurrence of phase-3 block alone in the Kent bundle was documented in 9 patients of the 17, phase-4 block alone in 1, and phase-3 and phase-4 block together with a typical accodion in 3. In 4 patients conduction in the Kent bundle was not modified. The phase-3 and phase-4 block as well as the accordion effect in the Kent bundle were similar to the same phenomena previously described in patients with diseased or in dogs with injured intraventricular conducting fascicles. The fact that the Kent bundle can show the same physiological and pharmacological behavior as a diseased His bundle or bundle branches is highly significant, first, because it may indicate that the anomalous bundle is also composed of Purkinje or Purkinje-like fibers and, secondly, because it may help to distinguish a normal from a diseased Kent bundle, and this may become essential for determining the prognosis and treatment of patients with WPW syndrome. The Kent bundle can be compared with a normal or diseased extra-His bundle.

Topics: Adolescent; Adult; Ajmaline; Amiodarone; Electrocardiography; Female; Heart Conduction System; Heart Rate; Humans; Male; Middle Aged; Wolff-Parkinson-White Syndrome

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: Ajmaline; Aniline Compounds; Anti-Arrhythmia Agents; Atrioventricular Node; Bundle of His; Depression, Chemical; Diethylamines; Electrocardiography; Heart Atria; Heart Conduction System; Heart Rate; Heart Ventricles; Humans; Indans; Metaproterenol; Oxprenolol; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Electrocardiography; Electrophysiology; Female; Heart Atria; Heart Block; Heart Conduction System; Heart Ventricles; Humans; Male; Middle Aged; Procainamide; Quinidine; Refractory Period, Electrophysiological; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Electrocardiography; Heart Block; Heart Conduction System; Humans; Isoproterenol; Wolff-Parkinson-White Syndrome

Topics: Acetanilides; Adrenergic beta-Antagonists; Ajmaline; Amino Alcohols; Anti-Arrhythmia Agents; Atrial Fibrillation; Heart Block; Heart Conduction System; Humans; Middle Aged; Phenytoin; Propylamines; Sinoatrial Node; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Ajmaline; Electrocardiography; Heart Conduction System; Humans; Male; Middle Aged; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Adult; Ajmaline; Atrial Fibrillation; Bundle-Branch Block; Digitalis Glycosides; Electrocardiography; Humans; Male; Wolff-Parkinson-White Syndrome

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

Topics: Adult; Aged; Ajmaline; Electric Stimulation; Electrocardiography; Heart Atria; Heart Block; Heart Conduction System; Humans; Male; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

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: Ajmaline; Digoxin; Electrocardiography; Furosemide; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Phytotherapy; Plants, Medicinal; Potassium; Rauwolfia; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: 1-Propanol; Ajmaline; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Quinolizines; Rauwolfia; Tachycardia, Paroxysmal; Tartrates; Wolff-Parkinson-White Syndrome

Topics: Ajmaline; Anti-Arrhythmia Agents; Cardiotonic Agents; Heart; Heart Block; Humans; Rauwolfia; Wolff-Parkinson-White Syndrome