disopyramide and Recurrence

This article summarizes current understandings and therapies for both arrhythmias. Atrial flutter is most often arising from a macroreentry circuit in the right atrium or around scar tissue in case or previous cardiothoracic surgery. As a macroreentrant tachycardia it is regular and can lead to higher heart rates, especially if occurring with 1:1 conduction. In contrast atrial fibrillation, especially when occurring paroxysmal at the beginning, is arising from triggers within the pulmonary veins. Ablation strategies to electrically isolate those triggers have a treatment success rate of 80%, which is much more than can be achieved with antiarrhythmic medication (success rates 30-50%). Emergency treatment of both arrhythmias include cardioversion and pacemaker implantation with AV node ablation if necessary.

Topics: Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Adult; Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Calcium Channel Blockers; Catheter Ablation; Clinical Trials as Topic; Disopyramide; Electric Countershock; Electrocardiography; Emergencies; Flecainide; Heart Rate; Humans; Middle Aged; Pacemaker, Artificial; Propafenone; Quinidine; Recurrence; Sotalol; Sulfonamides; Treatment Outcome; Vasodilator Agents

Among the drugs recommended to prevent recurrences of atrial fibrillation after external electric shock, antiarrhythmic agents of classes Ia (quinidine, disopyramide), Ic (cibenzoline, flecainide, propafenone) and III (sotalol) seem to have the same effectiveness in maintaining the sinus rhythm in about 50 percent of the cases after 6 months and one year. Amiodarone, seldom used as first-line treatment, appears to be the most effective drug. The percentage of side-effects requiring discontinuation of treatment is the same for all drugs (about 10 percent). All these drugs have potential proarrhythmic effects. In case of recurrence electric shocks can be repeated in some special cases. The therapeutic strategy according to the clinical context (atrial fibrillation of vagal nerve or catecholergic origin, normal or altered left ventricular function) is discussed.

Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Combined Modality Therapy; Disopyramide; Electric Countershock; Flecainide; Humans; Propafenone; Quinidine; Recurrence; Sotalol

Topics: Acetyldigoxins; Angiocardiography; Anti-Arrhythmia Agents; Cardiac Catheterization; Child; Dilatation, Pathologic; Disopyramide; Drug Therapy, Combination; Electrocardiography; Heart Atria; Heart Auscultation; Humans; Male; Recurrence; Tachycardia, Ectopic Junctional; Tachycardia, Paroxysmal

The aim of this multicenter, randomised, double-blind trial was to compare the efficacy and tolerance of oral disopyramide (D: 250 mg slow release twice daily) compared with cibenzoline (C: 130 mg twice daily) in the prevention of recurrences of atrial arrhythmias over a 6 month period. Sixty patients (mean age: 62 +/- 14 years; 37 men, 23 women; cardiac disease in 60% of cases) were randomised to two groups: C (N = 31) and D (N = 29). The commonest arrhythmia was atrial fibrillation (83%). The arrhythmia was recent (< 3 months) in 41% of patients and present for more than one year in 38% of patients. Sixteen patients of Group C (52%) and 11 of Group D (38%) had recurrences after an average of 79 +/- 58 days for Group C and 58 +/- 40 days for Group D (p = NS). The probability of absence of recurrence at 6 months was 36 +/- 11% in Group C and 55 +/- 10% in Group D (p = NS). Four patients in Group C (13%) and 13 patients in Group D (45%) had at least one unwanted side-effect (p = 0.009). Treatment was stopped because of side-effects in 2 patients in group C (6%) and 6 patients in Group D (21%). These results show that cibenzoline has a comparable efficacy for the prevention of recurrence of atrial tachyarrhythmia and is significantly better tolerated than disopyramide. This differences is mainly related to the marked anticholinergic effects of disopyramide.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Disopyramide; Double-Blind Method; Female; Humans; Imidazoles; Male; Middle Aged; Recurrence; Tachycardia

A double-blind randomized trial was designed to determine the efficacy of intravenous and oral disopyramide phosphate in preventing neurally mediated syncope induced by a head-up tilt test.. Neurally mediated syncope is a frequent cause of syncope and may be induced by head-up tilt testing. Recent uncontrolled trials have suggested that disopyramide may be an effective therapy in patients with neurally mediated syncope.. Twenty-two consecutive patients with recurrent neurally mediated syncope and two or more successive positive head-up tilt test responses were randomly allocated to receive either intravenous disopyramide or placebo. Head-up tilt testing at 60 degrees was performed for 15 min. If presyncope or syncope was not provoked, isoproterenol infusion was started at a rate of 1 microgram/min and the rate gradually increased until a 25% increase in heart rate was achieved. Eleven patients were subsequently randomized in crossover fashion to receive oral disopyramide (800 mg/day) or placebo during 1 week. The primary end point was prevention of syncope or presyncope provoked by head-up tilt testing.. Head-up tilt test results were positive for syncope in 12 (75%) of 16 patients receiving intravenous placebo and in 12 (60%) of 20 patients receiving disopyramide (p = 0.55 Fisher exact test, 95% confidence interval [CI] -14% to 40%). In the intravenous phase, complete crossover was achieved in 15 patients. Head-up tilt test results during this phase were positive in 13 patients (87%) receiving placebo and in 12 patients (80%) receiving disopyramide (p = 0.50 Fisher exact test, 95% CI -19% to 32%) and were positive in all patients receiving their initially randomized drug or placebo. In the oral phase, head-up tilt results were positive in only two patients (18%) assigned to placebo and in three patients (27%) receiving disopyramide (p = 0.54 Fisher exact test, 95% CI -42% to 24%). A mean follow-up time of 29 +/- 8 months was obtained in 21 of the 22 patients. Syncope recurred in 3 (27%) of the 11 patients receiving disopyramide and 3 (30%) of the 10 patients not treated pharmacologically (p > 0.05).. Intravenous disopyramide was ineffective for the prevention of neurally mediated syncope provoked by head-up tilt testing. No significant effect was observed after oral therapy with disopyramide. There was a striking decrease in the incidence of positive tilt test results over time regardless of intervention, thus discouraging the use of head-up tilt as the single method of assessing therapeutic efficacy. Recurrence of syncope after the investigative protocol was infrequent over long-term follow-up regardless of treatment group.

Topics: Administration, Oral; Adult; Disopyramide; Double-Blind Method; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Posture; Recurrence; Syncope; Time Factors

It is often suggested but never proven that atrial function is not affected during atrial flutter, nor after its conversion to normal sinus rhythm. To evaluate this hypothesis, a prospective study was performed in 22 patients (age range 20 to 88 years) with atrial flutter. Diastolic transmitral flow was analyzed with echo-Doppler before and after conversion. After randomization, conversion was attempted with overdrive pacing or up to two 50 J shocks. If the initial method was unsuccessful, a 200 J shock was administered. All patients were converted to sinus rhythm with this protocol. Shortly after conversion (at 1 and 6 hours), atrial contribution to ventricular filling was absent in 4 of 22 patients. In the remaining 18 patients, atrial contribution to ventricular filling was small. Atrial contribution to transmitral flow improved from 20 to 27% within 24 hours (p < 0.01) and increased further to 38% at 6 weeks (p < 0.005). Peak velocity of late diastolic filling increased from 0.28 m/s after 1 hour to 0.39 m/s after 24 hours (p < 0.0001) and improved even further during later follow-up. In 1 patient, an effective atrial systole was not observed until the 14th day. Cardiac output did not change significantly during the study period. No differences were observed between the conversion modalities. In conclusion, atrial dysfunction is present immediately after conversion of atrial flutter to normal sinus rhythm. This dysfunction occurs also after overdrive pacing and can last > 1 week. The findings suggest that stasis in the atria can remain temporarily present after successful conversion of atrial flutter to sinus rhythm.

Topics: Adult; Aged; Aged, 80 and over; Atrial Flutter; Atrial Function; Blood Flow Velocity; Cardiac Output; Cardiac Pacing, Artificial; Disopyramide; Echocardiography; Echocardiography, Doppler; Electric Countershock; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Recurrence

In order to compare the efficacy in preventing recurrencies of symptomatic atrial fibrillation of amiodarone (A.) and slow release disopyramide (D.RET.), 76 consecutive patients with recent onset atrial fibrillation (1 to 24 hrs.) were enrolled. In 20 (26%) conversion to sinus rhythm was obtained by electrical cardioversion, and in 56 (74%) by oral quinidine loading. Forty-one patients (group A) were assigned at random to treatment with D.RET. (250 mg twice daily) and 35 patients (group B) to amiodarone treatment (1200 mg daily for 10 days, and subsequently 200 mg daily). The two groups were similar as to age, sex and cardiac pathology. Patients were followed as to clinical condition, standard and dynamic ECG after one and three months and every three months subsequently for an average of 13.2 months (group A) and 14.1 months (group B). Six group A patients (14%) were excluded from follow-up on account of side effects which arose during the first week of treatment. Crises of symptomatic atrial fibrillation occurred in 20 patients of group A (57%) and in 11 (32%) group patients; this difference is statistically significant (p less than 0.05). Four (10%) group A patients stopped taking the drug due to side effects of an anticholinergic type, and three (8.5%) patients developed hyperthyroidism during follow-up. The authors therefore come to the conclusion that amiodarone is more effective than slow-release disopyramide in preventing recurrencies of atrial fibrillation; besides untoward side effects are less frequent with amiodarone.

Topics: Amiodarone; Analysis of Variance; Atrial Fibrillation; Delayed-Action Preparations; Disopyramide; Follow-Up Studies; Humans; Recurrence

Vasovagally mediated hypotension and bradycardia are believed to be common, but difficult to diagnose, causes of syncope. Upright tilt-table testing has been proposed as a possible way to test for vasovagal episodes. This study investigated the clinical utility of this technique in the evaluation and management of patients with syncope of unknown origin.. Twenty-five patients with recurrent unexplained syncope and six control subjects were evaluated by use of an upright tilt-table test for 30 minutes, with or without an infusion of isoproterenol (1 to 3 micrograms/minute given intravenously), in an attempt to provoke bradycardia, hypotension, or both. Of the 25 patients, there were 14 males and 11 females, with a mean age of 50 +/- 16 years. Six control patients with no history of syncope were also studied. All tilt-positive patients received therapy with either beta-blockers, disopyramide, transdermal scopolamine, or hydroflurocortisone, the efficacy of which was evaluated by another tilt-table test.. Syncope occurred in six patients (24%) during the baseline tilt and in nine patients (36%) during isoproterenol infusion (total positives, 60%). None of the controls had syncope during the test. All patients who had positive test results eventually became tilt-table-negative by therapy, and over a mean follow-up period of 16 +/- 2 months no further episodes have occurred.. From this study we conclude that upright tilt-table testing combined with isoproterenol infusion is clinically useful in the diagnosis of vasovagal syncope and the evaluation of pharmacologic therapy.

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Disopyramide; Female; Humans; Isoproterenol; Male; Methods; Middle Aged; Posture; Recurrence; Scopolamine; Syncope

The relative safety and efficacy of intravenous administration of adenosine, lignocaine, disopyramide, flecainide, and sotalol for termination of stable, induced ventricular tachycardia was assessed in serial trials. Ventricular tachycardia was terminated by pacing if it persisted 10-15 min after the end of drug administration. 24 patients with recurrent ventricular tachycardia were studied. Ventricular tachycardia was terminated by a drug in 35 of 105 trials. In 6 patients no drug terminated the arrhythmia. Adenosine did not terminate tachycardia or have any serious adverse effect in any patient; both flecainide and disopyramide were significantly more effective than lignocaine, but flecainide had significantly more severe adverse effects than lignocaine. Lignocaine was the safest drug and should continue to be used as first-line drug therapy for stable ventricular tachycardia. Disopyramide should be considered as second-line treatment. DC cardioversion is necessary for unstable ventricular tachycardia, and its availability must be ensured before attempted pharmacological intervention.

Topics: Adenosine; Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Clinical Trials as Topic; Disopyramide; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Electric Countershock; Electrocardiography; Flecainide; Humans; Hypotension; Injections, Intravenous; Lidocaine; Middle Aged; Recurrence; Sotalol; Tachycardia

The clinical analysis of the rhythmilene efficacy was performed in 247 patients receiving the drug for various arrhythmias. Due to its anticholinergic properties rhythmilene somewhat increased the sinus rhythm and improved atrioventricular conduction. These properties of the drug often caused urination retention, largely in males over 55 years. The drug was highly active in ventricular paroxysmal tachycardia and extrasystole. The scheme of an interrupted administration of rhythmilene and cordaron for preventing attacks of atrial fibrillation and flutter was worked out. The necessity of the systematic control of the duration of the Q-T interval is emphasized.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Clinical Trials as Topic; Disopyramide; Drug Therapy, Combination; Echocardiography; Electrocardiography; Heart Conduction System; Humans; Male; Middle Aged; Recurrence; Sinoatrial Node

A multi-centre double-blind randomized study is reported in which the effect on mortality of oral disopyramide (300 mg loading dose, then 100 mg qds) was compared with placebo in 1985 patients entering hospital with suspected acute myocardial infarction. Treatment was commenced with 24 hr of onset of symptoms (mean time to first dose 9 hr) and continued until discharge from hospital or 14 days, whichever came first. Nine-hundred and ninety-five patients were allocated to disopyramide and 990 to placebo. The overall mortality, calculated on an intention-to-treat basis, was 7.2% for the disopyramide and 5.6% for the placebo patients. Among those patients with proven infarction mortality was 9.5% of 687 on disopyramide and 7.4% of 716 on placebo. These differences are not statistically significant. Patients with cardiac failure or hypotension at entry did not fare worse on disopyramide, but those with a conduction defect did. Reinfarction was not significantly influenced by disopyramide. The prophylactic use of disopyramide in patients with suspected acute myocardial infarction does not reduce mortality or the incidence of early reinfarction.

Topics: Clinical Trials as Topic; Disopyramide; Double-Blind Method; Female; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Recurrence

Topics: Adult; Aged; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Clinical Trials as Topic; Disopyramide; Drug Evaluation; Female; Heart Failure; Humans; Lactose; Lactose Intolerance; Long-Term Care; Male; Middle Aged; Placebos; Pyridines; Recurrence; Tachycardia

Topics: Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Clinical Trials as Topic; Disopyramide; Electrocardiography; Electrophysiology; Female; Heart; Humans; Male; Middle Aged; Placebos; Pyridines; Recurrence

Early repolarization (ER) has been associated with an increased risk of sudden cardiac arrest. Interestingly, ventricular arrhythmias seem to be triggered by parasympathetic stimulation. In the present case report, we describe complete control of highly frequent malignant ventricular arrhythmias after adding theophylline to ineffective oral hydroquinidine and high-rate pacing in a patient suffering from malignant ER. We hypothesize that the theophylline-mediated enhanced beta-adrenergic stimulation could reduce the transmural myocardial voltage discrepancy by increasing the inward I

Topics: Anti-Arrhythmia Agents; Child; Defibrillators, Implantable; Disopyramide; Humans; Male; Quinidine; Recurrence; Tachycardia, Ventricular; Theophylline; Vasodilator Agents

A 67-year-old man who had cardiopulmonary arrest (CPA) at home was admitted to our institution. His spontaneous circulation was restored by bystander cardiopulmonary resuscitation (CPR) performed by his wife and an automated external defibrillator (AED). J waves were observed in the inferior leads of an electrocardiogram. We performed an implantable cardioverter defibrillator (ICD) implantation. After the ICD implantation, appropriate shocks due to ventricular fibrillation (VF) were observed on interrogation of the ICD at a frequency of twice a month. Most VF events occurred in the early morning between 1:00 to 6:00, and ventricular premature contractions (VPCs) were detected just before the occurrence of VF. Since the VF events always occurred in the early morning, we started long-acting disopyramide (150 mg/day, before bedtime), which has a muscarinic receptor blocking action. As a result, he has not received any appropriate ICD shocks for more than two years.

Topics: Aged; Anti-Arrhythmia Agents; Cardiopulmonary Resuscitation; Defibrillators, Implantable; Disopyramide; Electric Countershock; Electrocardiography; Heart Arrest; Humans; Male; Periodicity; Recurrence; Treatment Outcome; Ventricular Fibrillation

Topics: Aged; Anti-Arrhythmia Agents; Disopyramide; Female; Heart Arrest; Humans; Hypothermia, Induced; Long QT Syndrome; Recurrence; Survivors; Torsades de Pointes

Fetal supraventricular tachycardia confers an increased risk of cardiac failure, hydrops, and eventual intrauterine death. Although protocols for prenatal anti-arrhythmic treatment are now well established, few published reports discuss this condition in the setting of multiple pregnancies.. A 20-year-old primigravida woman with a twin pregnancy presented at 31 weeks of gestation for routine obstetrical check-up which revealed simultaneous supraventricular tachycardia in both fetuses. She was treated with oral digoxin, resulting in successful cardioversion in both of the fetuses, which was maintained until they were delivered by caesarian section at 38 weeks gestation. However, several hours after birth, tachyarrhythmias recurred in each of the infants. Combined disopyramide therapy with digoxin was necessary to control their heart rates.. The treatment of arrhythmia in fetuses of a multiple gestation presents unique issues, particularly when diagnosed prior to fetal lung maturity.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Digoxin; Disopyramide; Drug Therapy, Combination; Female; Fetal Diseases; Heart Rate; Humans; Infant, Newborn; Pregnancy; Pregnancy, Multiple; Recurrence; Tachycardia, Supraventricular; Twins

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Bundle-Branch Block; Disopyramide; Female; Humans; Myocardial Ischemia; Recurrence; Syncope

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Disopyramide; Humans; Medical History Taking; Nurse's Role; Pacemaker, Artificial; Patient Education as Topic; Physical Examination; Recurrence; Risk Factors; Selective Serotonin Reuptake Inhibitors; Syncope, Vasovagal

Previous studies suggest that vigorous myocardial contractions stimulate ventricular mechanoreceptors and lead to vasovagal syncope. We studied an endocardial index of myocardial contractility during the head-up tilt test in vasovagal patients and control patients, and we evaluated the effect of negative inotropic drugs on myocardial contractility and tilt test outcome.. We investigated 19 patients with recurrent vasovagal syncope and positive tilt test (group 1) and 11 patients with no syncope and negative tilt test (group 2). Myocardial contractility was continuously measured during a tilt test (60 degrees ) through a microaccelerometer incorporated in the tip of a right ventricular electrode to sense left ventricular contractility. Patients in groups 1 and 2 were evaluated during an unmedicated tilt test, and patients in group 1 were reevaluated during a tilt test with infusion of esmolol (n = 10) or disopyramide (n = 9). During the unmedicated test, patients in group 1 exhibited a significant increase in myocardial contractility immediately on postural change (P <.05), unlike patients in group 2. Patients in group 1 also had a further increase in myocardial contractility before the end of tilt (P <.01). With drug administration, the changes in supine myocardial contractility were nonsignificant and were not related with the outcome of the tilt test (P <.05).. An increase in myocardial contractility is detected by the sensor during the tilt test. The changes induced by the drugs on supine myocardial contractility are minor and not related with the outcome of the head-up tilt test.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Cardiotonic Agents; Disopyramide; Dobutamine; Electrodes, Implanted; Electrophysiology; Endocardium; Female; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Monitoring, Physiologic; Myocardial Contraction; Posture; Propanolamines; Recurrence; Retrospective Studies; Sensitivity and Specificity; Syncope, Vasovagal; Telemetry; Tilt-Table Test

A small percentage of pediatric patients with neurally mediated syncope will have an asystolic response during upright tilt table testing. The purpose of this study is to evaluate the incidence of asystole during tilt table testing, and to assess the outcome of medical management of such patients. Of 398 patients undergoing evaluation for recurrent syncope between January 1989 and 1994, 18 (4.5%) experienced asystole lasting > or = 5 seconds during baseline tilt test. Patients had experienced a mean of four episodes of syncope, with a mean age at the time of tilt test of 11.1 +/- 4.0 years. The median duration of asystole was 10 seconds (range 5-40 s). Treatment was individualized to increased fluids and salt intake (3 patients), metoprolol (8 patients), pseudoephedrine (4 patients), disopyramide (1 patient), or combination therapy with fludrohydrocortisone (2 patients). During a median duration of follow-up of 31 months, no additional syncope was experienced by 78% of patients. Recurrent syncope in 4 patients was associated with either noncompliance or discontinuation of therapy in 3 patients; in 1 patient, increasing the dose of metoprolol was effective in preventing recurrences. We conclude that young patients with recurrent syncope and asystole during tilt test may be safely and effectively managed with pharmacological therapy, without resorting to pacemaker implantation.

Topics: Adrenergic Agonists; Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Child; Cohort Studies; Disopyramide; Drug Combinations; Ephedrine; Fludrocortisone; Fluid Therapy; Follow-Up Studies; Heart Arrest; Humans; Incidence; Metoprolol; Pacemaker, Artificial; Recurrence; Safety; Sodium Chloride, Dietary; Syncope, Vasovagal; Tilt-Table Test; Time Factors; Treatment Outcome; Treatment Refusal

Recurrent neurocardiogenically mediated episodes of hypotension and bradycardia are a common cause of recurrent syncope that can be identified by head upright tilt table testing. While the use of beta-blockers, theophylline, fludrocortisone, disopyramide, and serotonin re-uptake inhibitors can be helpful in preventing further episodes, some patients are unresponsive to or poorly tolerant of these agents. We investigated the use of the central nervous system stimulant and peripheral vasoconstrictor methylphenidate in preventing both tilt induced and spontaneous neurocardiogenic syncope. Seven patients (all women, mean age 31 +/- 15 years) with recurrent syncope and positive head upright tilt induced hypotension/bradycardia (refractory to normal therapy) were placed on methylphenidate 10 mg orally three times per day. Six of the seven patients became both tilt negative and clinically asymptomatic over a 7-month follow-up period. We conclude that methylphenidate may be an effective therapy in patients with recurrent neurocardiogenic syncope refractory to other forms of therapy.

Topics: Administration, Oral; Adolescent; Adrenergic beta-Antagonists; Adult; Bradycardia; Central Nervous System Stimulants; Disopyramide; Female; Fludrocortisone; Follow-Up Studies; Humans; Hypotension; Methylphenidate; Middle Aged; Posture; Recurrence; Selective Serotonin Reuptake Inhibitors; Syncope; Theophylline; Tilt-Table Test; Vasoconstrictor Agents

The purpose of this study is to report on a series of patients who were referred for evaluation of syncope that occurred during or immediately after exercise and in whom a diagnosis of vasodepressor syncope was established (9 women and 8 men; mean age of 28 +/- 17 years). The approach to management was individualized in each patient. All patients were monitored to determine the frequency and type of recurrent symptoms. The mean age at onset of symptoms was 23 +/- 16 years. In 10 patients syncope occurred only in association with exercise. Pharmacologic therapy was successful in normalizing the patients' response to upright tilt in each of the 10 patients in whom it was attempted. During a mean follow-up period of 35 +/- 9 months, none of the patients placed on pharmacologic therapy has had recurrent syncope. Seventeen (88%) of 19 patients have resumed participation in athletics. The results of this study demonstrate that vasodepressor syncope is a cause of syncope in athletes and that patients with exercise-related vasodepressor syncope can safely continue to participate in athletics.

Topics: Adolescent; Adult; Age of Onset; Atenolol; Bradycardia; Disopyramide; Drug Combinations; Exercise; Exercise Test; Female; Follow-Up Studies; Humans; Hypotension, Orthostatic; Male; Middle Aged; Monitoring, Physiologic; Recurrence; Sports; Syncope; Tilt-Table Test

In order to determine the efficacy of type 1C agents (flecainide, encainide, propafenone) in patients with atrial fibrillation who have failed to maintain sinus rhythm with type 1A agents (quinidine, procainamide, disopyramide), 147 patients, that were admitted into the John Dempsey Hospital with new or recurrent atrial fibrillation between 1987-1991, were studied retrospectively. Out of the total, 29 patients converted spontaneously to sinus rhythm, 14 patients were left in atrial fibrillation, and 104 patients were given a type 1A antiarrhythmic. Sixty-five of these patients remained in sinus rhythm (54% converted on drug alone, 46% required electrical cardioversion) for at least 6 months. Of the remaining 39 patients, 28 were given a type 1C antiarrhythmic; 13 were successfully converted (61% chemical, 39% electrical) to and remained in sinus rhythm for at least 6 months; the remaining 15 either failed to convert or reverted to atrial fibrillation. New onset atrial fibrillation had a significantly lower incidence of congestive heart failure (10%) than recurrent atrial fibrillation (33%; P < 0.01). No differences in digoxin, beta blocker use, or other clinical characteristics were seen either between type 1A or type 1C successes or failures. Similarly, echocardiographic dimensions did not predict success or failure with either class of agent. In conclusion, type 1C antiarrhythmics for suppression of recurrent atrial fibrillation represent a reasonable therapeutic alternative for suppression of atrial fibrillation in patients who have failed type 1A agents. Prognostic factors predicting success or failure remain undetermined.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Disopyramide; Encainide; Female; Flecainide; Heart Rate; Humans; Male; Middle Aged; Procainamide; Propafenone; Quinidine; Recurrence; Retrospective Studies

The efficacy of permanent cardiac pacing in patients with neurocardiogenic (or vasovagal) syncope associated with bradycardia or asystole is not clear. We compared the efficacy of cardiac pacing with that of oral drug therapy in the prevention of hypotension and syncope during head-up tilt testing.. Among 70 patients with a history of syncope in whom hypotension and syncope could be provoked during head-up tilt testing, 22 had bradycardia (a heart rate < 60 beats per minute, with a decline in the rate by at least 20 beats per minute) or asystole along with hypotension during testing. There were 9 men and 13 women, with a mean (+/- SD) age of 41 +/- 17 years. Head-up tilt testing was repeated during atrioventricular sequential pacing (in 20 patients with sinus rhythm) or ventricular pacing (in 2 patients with atrial fibrillation). Regardless of the results obtained during artificial pacing, all the patients subsequently had upright-tilt testing repeated during therapy with oral metoprolol, theophylline, or disopyramide.. During the initial tilt test, 6 patients had asystole and 16 had bradycardia along with hypotension. Despite artificial pacing, the mean arterial pressure during head-up tilt testing still fell significantly, from 97 +/- 19 to 57 +/- 19 mm Hg (P < 0.001); 5 patients had syncope, and 15 had presyncope. By contrast, 19 patients who later received only medical therapy (metoprolol in 10, theophylline in 3, and disopyramide in 6), 2 patients who received both metoprolol and atrioventricular sequential pacing, and 1 patient who received only atrioventricular sequential pacing had negative head-up tilt tests. After a median follow-up of 16 months, 18 of the 19 patients who were treated with drugs alone (94 percent) remained free of recurrent syncope or presyncope, whereas the patient treated only with permanent dual-chamber pacemaker had recurrent syncope.. In patients with neurocardiogenic syncope associated with bradycardia or asystole, drug therapy is often effective in preventing syncope, whereas artificial pacing is not.

Topics: Adolescent; Adult; Aged; Bradycardia; Cardiac Pacing, Artificial; Disopyramide; Female; Follow-Up Studies; Heart Arrest; Humans; Hypotension; Male; Metoprolol; Middle Aged; Posture; Recurrence; Syncope; Theophylline

To investigate the usefulness of head-upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope.. Prospective survey.. Electrophysiology laboratory of a university hospital.. Twenty-five patients (11 male, 14 female; mean age 73 +/- 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 +/- 4 years).. Each patient underwent head-upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1-3 micrograms/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both.. Syncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow-up period of 24 months, no further syncopal episodes have occurred.. Head-upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.

Topics: Aged; Aged, 80 and over; Atenolol; Beds; Blood Pressure; Disopyramide; Drug Therapy, Combination; Electrocardiography; Electrophysiology; Female; Head; Humans; Isoproterenol; Male; Monitoring, Physiologic; Posture; Prospective Studies; Recurrence; Scopolamine; Syncope

The effectiveness and safety of internal transcatheter cardioversion on chronic lone atrial fibrillation were examined in ten patients resistant to external electrical (400 joules) and pharmacological cardioversion. Transcatheter cardioversion was performed by pulling back the atrioventricular junction catheter just inferior to the site of the His-bundle recording and delivering the shock between a proximal electrode (cathode) and backplate (anode). Transcatheter cardioversion restored sinus rhythm in all of the ten patients. The only complication observed was transient atrioventricular block after the shock and this was treated by temporary pacing. However, atrial fibrillation recurred in five patients at 30, 27, 52, 1, and 6 days, respectively. A second attempt at transcatheter cardioversion was performed in those patients an was successful in three patients. During a follow-up period ranging from 12 to 22 months, eight patients continued in sinus rhythm. Thus, transcatheter cardioversion is considered effective and safe in selected patients with chronic lone atrial fibrillation in whom external cardioversion was unsuccessful.

Topics: Atrial Fibrillation; Cardiac Catheterization; Cardiac Pacing, Artificial; Chronic Disease; Disopyramide; Electric Countershock; Female; Follow-Up Studies; Humans; Male; Middle Aged; Propafenone; Recurrence; Time Factors

We retrospectively studied 28 patients with 38 episodes of newly occurring ventricular fibrillation during antiarrhythmic drug therapy. Twenty-six of these patients, who had ventricular fibrillation during single-drug therapy with quinidine, procainamide, or disopyramide, were compared with a control group of 62 patients who had been treated similarly for ventricular arrhythmias but did not have ventricular fibrillation during treatment. The median duration of therapy before ventricular fibrillation was three days. The left ventricular ejection fraction of the study group was lower than that of the control group (0.29 vs. 0.43; P less than 0.0001), and concomitant treatment with digitalis and diuretic agents was more common in the study group. The base-line QT interval (corrected for heart rate) was slightly longer in the study group than in the controls (0.47 vs. 0.44; P less than 0.005), although both groups had similar degrees of QT prolongation during drug therapy. Four of 13 patients (31 percent) who underwent multiple trials of antiarrhythmic drugs had recurrent episodes of ventricular fibrillation. Six patients died suddenly after a mean follow-up of 18 months--four who were receiving antiarrhythmic therapy and two who were not. We conclude that drug-associated ventricular fibrillation is an early event, that there may be an increased risk of its recurrence with subsequent trials of antiarrhythmic drugs, and that left ventricular dysfunction and concomitant therapy with digitalis and diuretic agents may predispose patients to this complication.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Digitalis Glycosides; Disopyramide; Diuretics; Drug Therapy, Combination; Electrocardiography; Female; Humans; Male; Middle Aged; Procainamide; Quinidine; Recurrence; Retrospective Studies; Stroke Volume; Ventricular Fibrillation

We performed rhythm conversion on 33 euthyroid patients with post-thyrotoxic atrial fibrillation who do not revert spontaneously to sinus rhythm from atrial fibrillation. The duration of atrial fibrillation ranged from 9 to 59 months (mean 25 +/- 14). The protocol of rhythm conversion was to first attempt pharmacological conversion with disopyramide and then to perform electrical cardioversion on the non-converters. Of 33 patients, 25 were converted to sinus rhythm (6 by disopyramide and 19 by electrical cardioversion), resulting in 8 non-converters. However, it was later discovered that cardioversion had been applied to 4 of the 8 non-converters when these patients had had a recurrence of thyrotoxicosis. These 4 patients were subjected to a second electrical cardioversion after attaining the euthyroid state. Sinus rhythm was restored in all 4 patients, giving a cardioversion rate of 88%. The sinus rhythm was maintained in 25 of the total 29 converters (86%) at the time of follow-up (10-68 months, mean 35 +/- 19 months). Our studies suggest that cardioversion should be encouraged for thyrotoxic atrial fibrillation, even if the duration of atrial fibrillation is long-standing, since there is excellent maintenance of sinus rhythm and even delayed application of cardioversion may improve its success rate.

Topics: Adult; Atrial Fibrillation; Chronic Disease; Disopyramide; Electric Countershock; Electrocardiography; Female; Humans; Male; Middle Aged; Recurrence; Thyrotoxicosis

In this study, the safety and efficacy of long-term therapy with disopyramide phosphate were evaluated in 40 patients with documented, recurrent, symptomatic tachyarrhythmias. Twenty-one (53%) of the patients had organic heart disease, and nine of these patients had compensated congestive heart failure. The tachyarrhythmias which were treated were paroxysmal supraventricular tachycardia (21 patients), paroxysmal atrial fibrillation (six patients), and paroxysmal ventricular tachycardia (13 patients). In each patient there was evidence, from continuous ECG monitoring or electrophysiologic testing, that disopyramide would be effective therapy, and each patient was able to tolerate disopyramide (no side effects or tolerable side effects) during an initial trial period of 1 to 2 weeks. Dosages of disopyramide were 400 to 1600 mg/day (994 +/- 320 mm/day). During long-term therapy, side effects were reported by 28 (70%) of the patients. The side effects were usually anticholinergic, and were usually a continuation of side effects noted during the initial trial period. None of the patients had idiosyncratic reactions to disopyramide. Most of the patients found side effects to be tolerable; however, in seven patients it was necessary to discontinue disopyramide after 1 to 8 (6 +/- 3) months. Actuarial incidence of intolerable side effects was 21 +/- 7% at 12 months. Nine (22%) of the 40 patients had symptomatic recurrences of tachyarrhythmia after 3 to 32 (15 +/- 9) months of therapy. Actuarial incidence of drug ineffectiveness was 32 +/- 10% at 24 months. Disopyramide was both effective and tolerated in 24 (60%) of the patients, who were followed for 2 to 64 (23 +/- 16) months.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Disopyramide; Drug Tolerance; Electrocardiography; Female; Humans; Male; Middle Aged; Recurrence; Tachycardia, Paroxysmal; Time Factors

Fifty-one patients were treated with mexiletine over 10.4 +/- 16 months. The clinical arrhythmia in 25 (49%) was ventricular fibrillation (VF), 11 (22%) had sustained ventricular tachycardia (VT), and 15 (29%) had symptomatic nonsustained VT. Ischemic heart disease was present in 33 patients (66%), cardiomyopathy in nine (17%), and valvular or congenital heart disease in nine (17%). Only six (12%) remain on the drug. Arrhythmias recurred in 21 patients (41%): seven (14%) with VF, three (5%) with sustained VT, and 11 (22%) with symptomatic nonsustained VT. Intolerable side effects occurred in another 17 (33%). Seven patients (14%) died from nonarrhythmic-related deaths while taking mexiletine. Mexiletine was combined with a conventional type IA antiarrhythmic agent in 25 patients (49%). In 12 of these 25 patients (48%), ventricular arrhythmias recurred. These findings were not significantly different from those of the group treated with mexiletine alone, where arrhythmias recurred in 9 of 26 patients (35%) (p = NS). Thus mexiletine, alone or in combination with a type IA antiarrhythmic agent, has limited clinical utility in patients with life-threatening ventricular arrhythmias.

Topics: Cardiac Pacing, Artificial; Disopyramide; Drug Therapy, Combination; Electrocardiography; Electrophysiology; Female; Humans; Male; Mexiletine; Middle Aged; Monitoring, Physiologic; Nausea; Procainamide; Propylamines; Quinidine; Recurrence; Tachycardia; Tremor; Ventricular Fibrillation

The purpose of our study was to assess the efficacy of Propafenon in comparison with Disopyramide in the long-term treatment of repetitive ventricular tachycardia. We studied 34 patients suffering from episodes of repetitive ventricular tachycardia of different etiology. Propafenon and Disopyramide was administered in doses of 300 mg and 200 mg three times a day respectively. The number of ventricular tachycardias has been evaluated during a period of 4 months of basal observation and during two periods of 4 months each of treatment respectively with Disopyramide and Propafenon. Moreover a dynamic electrocardiogram was recorded to assess the efficacy of Propafenon in suppressing ventricular ectopic beats in 17 patients. We conclude that Propafenon shows greater efficacy than Disopyramide in the treatment of repetitive ventricular tachycardias and a comparable efficacy in the control of ventricular ectopic beats. Moreover Propafenon shows also a minor incidence of side effects.

Topics: Anti-Arrhythmia Agents; Disopyramide; Drug Evaluation; Heart Ventricles; Humans; Propafenone; Propiophenones; Recurrence; Tachycardia

Topics: Adult; Aged; Arrhythmias, Cardiac; Disopyramide; Drug Evaluation; Female; Heart Ventricles; Humans; Injections, Intravenous; Male; Middle Aged; Recurrence

We performed serial electrophysiological-pharmacological studies on 21 patients with recurrent sustained or non-sustained ventricular tachycardia (VT). In 8 of 11 patients with recurrent sustained VT, VT could be induced repeatedly by programmed electrical stimulation and terminated by ventricular burst pacing. In 13 of the 21 patients, repetitive ventricular response (RVR) was successfully induced. In the 8 patients with induced VT, the efficacy of several antiarrhythmic drugs intravenously administered was assessed. Procainamide prevented the initiation of VT in 57%, disopyramide in 50% and mexiletine in 40%. However, lidocaine, propranolol and verapamil could not prevent VT in any of 5, 3 and 6 patients, respectively. Verapamil in combination with quinidine prevented the initiation of VT in one case. Each of disopyramide, propranolol and verapamil increased the VT zone in 2 patients. The drugs belonging to the same group classified by their electrophysiological properties were not interchangeable in 2 patients. Their ability to terminate induced VT did not always correlate with that to prevent its initiation in 2 patients. The effects of specific drugs were rather variable and unpredictable in each patients, and especially those of combination regimens using more than 2 antiarrhythmic drugs were more unpredictable. In all patients, the induced VT was morphologically identical to the spontaneously occurring VT and its rate was ranged within 13% of that of the spontaneously VT. In 10 of 13 patients with RVR, QRS configuration of RVR was not similar to the spontaneously occurring arrhythmia. The pharmacological suppression of RVR as an index for prevention against spontaneous VT remains controversial. This study concludes that the serial electrophysiological-pharmacological study provides a rapid prediction of effectiveness of a particular regimen and combination and a rapid identification of the deleterious effects of certain drugs in patients with recurrent sustained VT.

Topics: Adolescent; Adult; Aged; Anti-Arrhythmia Agents; Disopyramide; Electric Stimulation; Electrocardiography; Female; Humans; Lidocaine; Male; Mexiletine; Middle Aged; Procainamide; Recurrence; Tachycardia; Verapamil

Oral antiarrhythmic treatment with mexiletine and disopyramide was evaluated in 34 patients with recurrent sustained ventricular tachycardias by programmed ventricular stimulation, except in a few instances where spontaneous attacks occurred under therapy. Coronary heart disease was present in 17 patients, cardiomyopathy in 11, myocarditis in five, and mitral valve prolapse in one. Complete suppression of ventricular tachycardia was observed in three of 30 patients under mexiletine and in one of 25 patients under disopyramide. Disopyramide slowed the rate of the ventricular tachycardia considerably, while mexiletine had no such influence. For a mean of 24 months, 19 patients were maintained on either substance. Complete suppression of ventricular tachycardia during programmed stimulation predicted freedom from recurrences. Ventricular tachycardias recurred less frequently and at a slower rate in the other patients, but 31% have died. This study shows that complete suppression of ventricular tachycardia by mexiletine or disopyramide can be achieved only in a minority of patients with previously drug-resistant tachycardias.

Topics: Adult; Aged; Cardiac Pacing, Artificial; Disopyramide; Female; Humans; Male; Mexiletine; Middle Aged; Propylamines; Pyridines; Recurrence; Retrospective Studies; Tachycardia

Topics: Aged; Amiodarone; Disopyramide; Electrocardiography; Heart Conduction System; Humans; Male; Procainamide; Quinidine; Recurrence; Tachycardia

Topics: Adult; Atrial Fibrillation; Disopyramide; Heart Valve Diseases; Humans; Middle Aged; Premedication; Pyridines; Recurrence

Topics: Adult; Aged; Arrhythmias, Cardiac; Cardiac Pacing, Artificial; Disopyramide; Electrocardiography; Female; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Phenytoin; Postoperative Complications; Procainamide; Propranolol; Recurrence; Tachycardia

Topics: Administration, Oral; Adult; Aged; Disopyramide; Electric Stimulation; Female; Follow-Up Studies; Heart; Hemodynamics; Humans; Male; Middle Aged; Pyridines; Recurrence; Tachycardia; Time Factors

1 Reccurent paroxysmal atrial, atrioventricular and ventricular tachycardias in 50 patients without acute coronary insufficiency, heart failure or metabolic abnormlity were treated with disopyramide phosphate in a dose of 2 mg/kg body weight infused over 5 min. 2 Conversion to sinus rhythm within 10 min of the completed infusion occurred in 10 of 14 (71%) patients with paroxysmal 'lone' atrial fibrillation, 3 of 7 (43%) patients with paroxysmal atrial flutter, 6 of 9 (67%) patients with paroxysmal atrial tachycardia, 5 of 9 (56%) patients with paroxysmal atrioventricular tachycardia associated with the Wolff-Parkinson-White syndrome and 8 of 11 (73%) patients with paroxysmal ventricular tachycardia. 3 Side effects: significant systemic hypotension in 3, high grade AV block in 1, an increased ventricular response producing symptoms in 4, post conversion asystole in 1 land sinus bradycardia in 2. 4 The anti-arrhythmic effect and arrhythmogenic side effects may be related to both the direct membrane stabilizing effect and the anticholinergic effect of disopyramide.

Topics: Atrial Fibrillation; Atrial Flutter; Blood Pressure; Disopyramide; Electrocardiography; Humans; Infusions, Parenteral; Pyridines; Recurrence; Tachycardia, Paroxysmal; Time Factors

We performed intracardiac electrophysiologic studies in 33 patients with recurrent ventricular tachycardia. Nineteen patients underwent one, 10 patients two, and four patients three serial electrophysiologic studies. Ventricular tachycardia was successfully induced in 83% of the patients, and pacing methods were successful in terminating tachycardia in 71% of the studies, although pacing-induced acceleration of ventricular tachycardia occurred at least once in 36% of the studies. Seventeen of the 33 patients (52%) required a total of 24 external direct current cardioversions during study. In 21 patients a variety of antiarrhythmic drugs were given I.V. and attempts at ventricular tachycardia induction were repeated to assess prophylactic effects of the drugs. An acutely effective drug or combination of drugs was found in 15 of the patients (71%). Fourteen of the 15 were placed on chronic oral therapy with the effective agent and were followed for an average period of 8.1 months (range one to 33 months). In all 14 patients we could document complete (13 patients) or partial (one patient) long-term prophylaxis against ventricular tachycardia. We conclude that drug efficacy trials in patients with recurrent ventricular tachycardia using intracardiac pacing techniques is a rapid and accurate method of selecting effective long-term antiarrhythmic therapy.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Disopyramide; Drug Evaluation; Electric Countershock; Electrocardiography; Female; Follow-Up Studies; Humans; Injections, Intravenous; Lidocaine; Male; Middle Aged; Monitoring, Physiologic; Phenytoin; Procainamide; Propranolol; Quinidine; Recurrence; Tachycardia

Twenty patients with recurrent sustained ventricular tachycardia (VT) underwent serial electrophysiological studies (EPS) 1) to determine the predictive value of the EPS in the selection of antiarrhythmic therapy, and 2) to establish the therapeutic efficacy of available antiarrhythmic agents. In each patient VT could be reproducibly initiated by programmed stimulation. After control EPS, the effects of several drugs (lidocaine, procainamide, quinidine, disopyramide and diphenylhydantoin) on the ability to initiate VT were assessed. An oral regimen was chosen on the basis of acute EPS and its effectiveness was evaluated by repeat EPS in 24--72 hours. Blood levels achieved acutely were used as guidelines to chronic therapy. In 14 patients the initiation of VT was prevented by the acute administration of one or more agents. In 13 of these patients, a chronic oral regimen based on these results prevented recurrence of VT with a three- to 27-month follow-up. In the remaining patient, oral therapy could not achieve blood levels of procainamide shown to be effective intravenously, and VT recurred. In six patients no single drug or drug combination was effective during acute EPS, and VT recurred in all while on therapy with the agent shown to make initiation of VT most difficult. Procainamide prevented VT in nine patients; quinidine in three patients; lidocaine in three patients; diphenylhydantoin in two patients; and disopyramide in one patient. The mean duration of EPS studies was 4.5 days. This study suggests that serial EPS provides rapid identification of successful antiarrhythmic therapy and can predict in which patients conventional therapy would be ineffective, thereby identifying patients requiring more aggressive modes of therapy.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Disopyramide; Drug Evaluation; Drug Therapy, Combination; Electric Countershock; Electrocardiography; Female; Follow-Up Studies; Humans; Injections, Intravenous; Lidocaine; Male; Middle Aged; Phenytoin; Procainamide; Quinidine; Recurrence; Tachycardia

Topics: Aged; Arrhythmias, Cardiac; Disopyramide; Drug Evaluation; Humans; Middle Aged; Myocardial Infarction; Pyridines; Recurrence; United Kingdom

A 66-year-old man suffered an acute myocardial infarction complicated by multiple episodes of ventricular tachycardia and 96 episodes of ventricular fibrillation requiring cardioversion over a period of 55 days. Following ventricular aneurysmectomy, the ventricular tachycardia persisted. This converted to regular sinus rhythm with a regimen of disopyramide phosphate, quinidine, and propranolol.

Topics: Aged; Disopyramide; Electric Countershock; Heart Aneurysm; Humans; Male; Myocardial Infarction; Propranolol; Quinidine; Recurrence; Tachycardia; Ventricular Fibrillation

Topics: Aged; Disopyramide; Humans; Lidocaine; Male; Pyridines; Recurrence; Ventricular Fibrillation