Value of a revised procainamide test in the Wolff-Parkinson-White syndrome
Identifieur interne : 004918 ( Main/Exploration ); précédent : 004917; suivant : 004919Value of a revised procainamide test in the Wolff-Parkinson-White syndrome
Auteurs : K. Atta Boahene [Canada] ; George J. Klein [Canada] ; Arjun D. Sharma [Canada] ; Raymond Yee [Canada] ; Osamu Fujimura [Canada]Source :
- The American Journal of Cardiology [ 0002-9149 ] ; 1990.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Antiarrhythmia agent, Arrhythmia, Atrial Fibrillation (physiopathology), Cardiovascular disease, Conduction disorder, Dose-Response Relationship, Drug, Electrocardiography, Evaluation Studies as Topic, Excitability disorder, Female, Heart Conduction System (physiopathology), Heart Function Tests (standards), Human, Humans, Male, Middle Aged, Perfusion, Procainamide, Refractory Period, Electrophysiological, Risk factor, Screening, Sudden death, Wolff Parkinson White syndrome, Wolff-Parkinson-White Syndrome (diagnosis), Wolff-Parkinson-White Syndrome (physiopathology).
- MESH :
- chemical : Procainamide.
- diagnosis : Wolff-Parkinson-White Syndrome.
- physiopathology : Atrial Fibrillation, Heart Conduction System, Wolff-Parkinson-White Syndrome.
- standards : Heart Function Tests.
- Adolescent, Adult, Aged, Dose-Response Relationship, Drug, Electrocardiography, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Refractory Period, Electrophysiological.
Abstract
A shortest preexcited RR interval < 250 ms during atrial fibrillation identifies the patient with Wolff-Parkinson-White syndrome potentially at risk for ventricular fibrillation. Loss of preexcitation after infusion of up to 10 mg/kg of procainamide during sinus rhythm has been reported to correlate with a slow ventricular response during atrial fibrillation and has been proposed as a noninvasive test to establish risk of sudden death in these patients. Others have failed to establish this relation and have questioned the usefulness of the procainamide test. Such conflicting results were hypothesized to be a result of differing dosages and methodology. Consequently, this study tested the effect of incremental doses of procainamide (to a cumulative dose of 1 g) on the anterograde effective refractory period of the accessory pathway and related the reliability of the procainamide test to the dose at which preexcitation was lost. The effect of procainamide on the anterograde effective refractory period of the accessory pathway was dose dependent; patients who lost preexcitation had a steeper dose-response curve. Loss of preexcitation by a cumulative dose of 550 mg provided the best balance for sensitivity (60%) and specificity (89%) in identifying patients with preexcited shortest RR >250 ms. Specificity fell steeply after this dosage and higher doses were not useful. The diagnostic accuracy of the procainamide test is critically related to dosage and method of infusion.
Url:
DOI: 10.1016/0002-9149(90)90084-E
Affiliations:
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Le document en format XML
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Atta" last="Boahene">K. Atta Boahene</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Fujimura, Osamu" sort="Fujimura, Osamu" uniqKey="Fujimura O" first="Osamu" last="Fujimura">Osamu Fujimura</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="ISSN">0002-9149</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1990">1990</date><biblScope unit="volume">65</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="195">195</biblScope><biblScope unit="page" to="200">200</biblScope></imprint><idno type="ISSN">0002-9149</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Antiarrhythmia agent</term><term>Arrhythmia</term><term>Atrial Fibrillation (physiopathology)</term><term>Cardiovascular disease</term><term>Conduction disorder</term><term>Dose-Response Relationship, Drug</term><term>Electrocardiography</term><term>Evaluation Studies as Topic</term><term>Excitability disorder</term><term>Female</term><term>Heart Conduction System (physiopathology)</term><term>Heart Function Tests (standards)</term><term>Human</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Perfusion</term><term>Procainamide</term><term>Refractory Period, Electrophysiological</term><term>Risk factor</term><term>Screening</term><term>Sudden death</term><term>Wolff Parkinson White syndrome</term><term>Wolff-Parkinson-White Syndrome (diagnosis)</term><term>Wolff-Parkinson-White Syndrome (physiopathology)</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Procainamide</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Wolff-Parkinson-White Syndrome</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Atrial Fibrillation</term><term>Heart Conduction System</term><term>Wolff-Parkinson-White Syndrome</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Heart Function Tests</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Dose-Response Relationship, Drug</term><term>Electrocardiography</term><term>Evaluation Studies as Topic</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Refractory Period, Electrophysiological</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Antiarythmique</term><term>Appareil circulatoire pathologie</term><term>Dépistage</term><term>Facteur risque</term><term>Homme</term><term>Mort subite</term><term>Perfusion</term><term>Procaïnamide</term><term>Trouble conduction</term><term>Trouble excitabilité</term><term>Trouble rythme cardiaque</term><term>Wolff Parkinson White syndrome</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A shortest preexcited RR interval < 250 ms during atrial fibrillation identifies the patient with Wolff-Parkinson-White syndrome potentially at risk for ventricular fibrillation. Loss of preexcitation after infusion of up to 10 mg/kg of procainamide during sinus rhythm has been reported to correlate with a slow ventricular response during atrial fibrillation and has been proposed as a noninvasive test to establish risk of sudden death in these patients. Others have failed to establish this relation and have questioned the usefulness of the procainamide test. Such conflicting results were hypothesized to be a result of differing dosages and methodology. Consequently, this study tested the effect of incremental doses of procainamide (to a cumulative dose of 1 g) on the anterograde effective refractory period of the accessory pathway and related the reliability of the procainamide test to the dose at which preexcitation was lost. The effect of procainamide on the anterograde effective refractory period of the accessory pathway was dose dependent; patients who lost preexcitation had a steeper dose-response curve. Loss of preexcitation by a cumulative dose of 550 mg provided the best balance for sensitivity (60%) and specificity (89%) in identifying patients with preexcited shortest RR >250 ms. Specificity fell steeply after this dosage and higher doses were not useful. The diagnostic accuracy of the procainamide test is critically related to dosage and method of infusion.</div></front></TEI><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Boahene, K Atta" sort="Boahene, K Atta" uniqKey="Boahene K" first="K. Atta" last="Boahene">K. Atta Boahene</name></noRegion><name sortKey="Fujimura, Osamu" sort="Fujimura, Osamu" uniqKey="Fujimura O" first="Osamu" last="Fujimura">Osamu Fujimura</name><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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