Vagal techniques for termination of paroxysmal supraventricular tachycardia
Identifieur interne : 005215 ( Main/Exploration ); précédent : 005214; suivant : 005216Vagal techniques for termination of paroxysmal supraventricular tachycardia
Auteurs : Menashe B. Waxman [Canada] ; Robert W. Wald [Canada] ; Arjun D. Sharma [Canada] ; Felix Huerta [Canada] ; Douglas A. Cameron [Canada]Source :
- The American Journal of Cardiology [ 0002-9149 ] ; 1980.
Abstract
Maneuvers that reflexly increase vagal tone were deployed to terminate the tachycardia in 68 consecutive patients with paroxysmal supraventricular tachycardia. The order and success rate of the protocol was as follows: 57 episodes were terminated with carotid sinus pressure alone or after pretreatment with edrophonium, 5 were terminated with the Valsalva maneuvers and 6 were terminated with phenylephrine. Potency testing showed that phenylephrine evoked the greatest increase in vagal tone. All cases demonstrated slowing of tachycardia ranging from 40 to 220 ms ± standard error of the mean (mean 79.0 ± 3.8 ms) followed by abrupt termination. Pauses after termination ranged from 900 to 3,300 ms (mean 1,683.8 ± 66.6) with 54 patients showing pauses of 2,000 ms or less. Termination was highly reproducible showing an overall success of 148 (92 percent) of 160 trials among 22 selected cases. The extent of increased vagal tone needed to terminate paroxysmal supraventricular tachycardia was raised by augmented sympathetic tone (infusion of isoproterenol) and decreased by reduced sympathetic tone (pretreatment with propranolol). Thus, paroxysmal supraventricular tachycardia can be rapidly, safely and consistently terminated by maneuvers that reflexly increase vagal tone.
Url:
DOI: 10.1016/0002-9149(80)90517-2
Affiliations:
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Sharma</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University of Toronto Faculty of Medicine and Division of Cardiology of the Toronto General Hospital, Toronto, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Huerta, Felix" sort="Huerta, Felix" uniqKey="Huerta F" first="Felix" last="Huerta">Felix Huerta</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University of Toronto Faculty of Medicine and Division of Cardiology of the Toronto General Hospital, Toronto, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Cameron, Douglas A" sort="Cameron, Douglas A" uniqKey="Cameron D" first="Douglas A." last="Cameron">Douglas A. Cameron</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Department of Medicine, University of Toronto Faculty of Medicine and Division of Cardiology of the Toronto General Hospital, Toronto, 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="1980">1980</date><biblScope unit="volume">46</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="655">655</biblScope><biblScope unit="page" to="664">664</biblScope></imprint><idno type="ISSN">0002-9149</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Maneuvers that reflexly increase vagal tone were deployed to terminate the tachycardia in 68 consecutive patients with paroxysmal supraventricular tachycardia. The order and success rate of the protocol was as follows: 57 episodes were terminated with carotid sinus pressure alone or after pretreatment with edrophonium, 5 were terminated with the Valsalva maneuvers and 6 were terminated with phenylephrine. Potency testing showed that phenylephrine evoked the greatest increase in vagal tone. All cases demonstrated slowing of tachycardia ranging from 40 to 220 ms ± standard error of the mean (mean 79.0 ± 3.8 ms) followed by abrupt termination. Pauses after termination ranged from 900 to 3,300 ms (mean 1,683.8 ± 66.6) with 54 patients showing pauses of 2,000 ms or less. Termination was highly reproducible showing an overall success of 148 (92 percent) of 160 trials among 22 selected cases. The extent of increased vagal tone needed to terminate paroxysmal supraventricular tachycardia was raised by augmented sympathetic tone (infusion of isoproterenol) and decreased by reduced sympathetic tone (pretreatment with propranolol). Thus, paroxysmal supraventricular tachycardia can be rapidly, safely and consistently terminated by maneuvers that reflexly increase vagal tone.</div></front></TEI><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Waxman, Menashe B" sort="Waxman, Menashe B" uniqKey="Waxman M" first="Menashe B." last="Waxman">Menashe B. Waxman</name></noRegion><name sortKey="Cameron, Douglas A" sort="Cameron, Douglas A" uniqKey="Cameron D" first="Douglas A." last="Cameron">Douglas A. Cameron</name><name sortKey="Huerta, Felix" sort="Huerta, Felix" uniqKey="Huerta F" first="Felix" last="Huerta">Felix Huerta</name><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name><name sortKey="Wald, Robert W" sort="Wald, Robert W" uniqKey="Wald R" first="Robert W." last="Wald">Robert W. 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