Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern
Identifieur interne : 000157 ( Main/Corpus ); précédent : 000156; suivant : 000158Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern
Auteurs : Tibor S. Szabo ; George J. Klein ; Arjun D. Sharma ; Raymond Yee ; Simon MilsteinSource :
- The American Journal of Cardiology [ 0002-9149 ] ; 1988.
Abstract
The asymptomatic individual with a Wolff-Parkinson-White (WPW) pattern is considered at risk for ventricular fibrillation if a rapid ventricular response (shortest RR interval ≤ 250 ms) is observed during induced atrial fibrillation (AF) in the laboratory. It has been suggested that isoproterenol administration during AF may more accurately define the patient at risk. Consequently, the effect of isoproterenol on ventricular response during AF was studied in 21 asymptomatic individuals with WPW pattern to assess the potential of isoproterenol to identify patients at risk for sudden death. An electrophysiologic study that included elective induction of AF was performed. The shortest and mean RR intervals between 2 consecutive preexcited and normal QRS complexes, the average RR interval and the proportion of preexcited QRS complexes were measured in the control state and after bolus injections of isoproterenol (0.5, 1.0, 2.0 and 4.0 μg) during AF. Both atrioventricular nodal and accessory pathway conductions were enhanced proportional to isoproterenol dose. Isoproterenol had a greater effect on the atrioventricular node, as reflected by significantly greater changes in the shortest RR between normal complexes (339 ± 70 vs 255 ±21 ms, mean ± standard deviation, p < 0.001) than the shortest RR between preexcited complexes (264 ± 39 vs 219 ± 34 ms, p < 0.001) and a decrease in percentage of preexcited complexes (65 ± 37 vs 50 ± 33%, p < 0.01). After isoproterenol, 67% of patients had a shortest RR between preexcited complexes ≤ 250 ms, the traditional marker of risk for ventricular fibrillation, versus 33% in the control state. These results suggest that isoproterenol predictably accelerates the ventricular response in patients with asymptomatic WPW syndrome primarily by enhancement of atrioventricular nodal conduction. Shortening of the shortest RR interval between preexcited complexes to 250 ms occurred in 67% of patients and would be expected to have poor specificity as a potential prognosticator of ventricular fibrillation.
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DOI: 10.1016/0002-9149(89)90283-X
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern</title><author><name sortKey="Szabo, Tibor S" sort="Szabo, Tibor S" uniqKey="Szabo T" first="Tibor S." last="Szabo">Tibor S. Szabo</name><affiliation><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></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><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></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><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Milstein, Simon" sort="Milstein, Simon" uniqKey="Milstein S" first="Simon" last="Milstein">Simon Milstein</name><affiliation><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:E5AC313F85EE082493CF4D674CCB88FF1011D1D1</idno><date when="1989" year="1989">1989</date><idno type="doi">10.1016/0002-9149(89)90283-X</idno><idno type="url">https://api.istex.fr/document/E5AC313F85EE082493CF4D674CCB88FF1011D1D1/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000157</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern</title><author><name sortKey="Szabo, Tibor S" sort="Szabo, Tibor S" uniqKey="Szabo T" first="Tibor S." last="Szabo">Tibor S. Szabo</name><affiliation><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></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><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></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><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Milstein, Simon" sort="Milstein, Simon" uniqKey="Milstein S" first="Simon" last="Milstein">Simon Milstein</name><affiliation><mods:affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</mods:affiliation></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="1988">1988</date><biblScope unit="volume">63</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="187">187</biblScope><biblScope unit="page" to="192">192</biblScope></imprint><idno type="ISSN">0002-9149</idno></series><idno type="istex">E5AC313F85EE082493CF4D674CCB88FF1011D1D1</idno><idno type="DOI">10.1016/0002-9149(89)90283-X</idno><idno type="PII">0002-9149(89)90283-X</idno><idno type="ArticleID">8990283X</idno></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">The asymptomatic individual with a Wolff-Parkinson-White (WPW) pattern is considered at risk for ventricular fibrillation if a rapid ventricular response (shortest RR interval ≤ 250 ms) is observed during induced atrial fibrillation (AF) in the laboratory. It has been suggested that isoproterenol administration during AF may more accurately define the patient at risk. Consequently, the effect of isoproterenol on ventricular response during AF was studied in 21 asymptomatic individuals with WPW pattern to assess the potential of isoproterenol to identify patients at risk for sudden death. An electrophysiologic study that included elective induction of AF was performed. The shortest and mean RR intervals between 2 consecutive preexcited and normal QRS complexes, the average RR interval and the proportion of preexcited QRS complexes were measured in the control state and after bolus injections of isoproterenol (0.5, 1.0, 2.0 and 4.0 μg) during AF. Both atrioventricular nodal and accessory pathway conductions were enhanced proportional to isoproterenol dose. Isoproterenol had a greater effect on the atrioventricular node, as reflected by significantly greater changes in the shortest RR between normal complexes (339 ± 70 vs 255 ±21 ms, mean ± standard deviation, p < 0.001) than the shortest RR between preexcited complexes (264 ± 39 vs 219 ± 34 ms, p < 0.001) and a decrease in percentage of preexcited complexes (65 ± 37 vs 50 ± 33%, p < 0.01). After isoproterenol, 67% of patients had a shortest RR between preexcited complexes ≤ 250 ms, the traditional marker of risk for ventricular fibrillation, versus 33% in the control state. These results suggest that isoproterenol predictably accelerates the ventricular response in patients with asymptomatic WPW syndrome primarily by enhancement of atrioventricular nodal conduction. Shortening of the shortest RR interval between preexcited complexes to 250 ms occurred in 67% of patients and would be expected to have poor specificity as a potential prognosticator of ventricular fibrillation.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Tibor S. Szabo MD</name><affiliations><json:string>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</json:string></affiliations></json:item><json:item><name>George J. Klein MD</name><affiliations><json:string>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Arjun D. Sharma MD</name><affiliations><json:string>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Raymond Yee MD</name><affiliations><json:string>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Simon Milstein MD</name><affiliations><json:string>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Arrhythmias and conduction disturbances</value></json:item></subject><articleId><json:string>8990283X</json:string></articleId><language><json:string>eng</json:string></language><abstract>The asymptomatic individual with a Wolff-Parkinson-White (WPW) pattern is considered at risk for ventricular fibrillation if a rapid ventricular response (shortest RR interval ≤ 250 ms) is observed during induced atrial fibrillation (AF) in the laboratory. It has been suggested that isoproterenol administration during AF may more accurately define the patient at risk. Consequently, the effect of isoproterenol on ventricular response during AF was studied in 21 asymptomatic individuals with WPW pattern to assess the potential of isoproterenol to identify patients at risk for sudden death. An electrophysiologic study that included elective induction of AF was performed. The shortest and mean RR intervals between 2 consecutive preexcited and normal QRS complexes, the average RR interval and the proportion of preexcited QRS complexes were measured in the control state and after bolus injections of isoproterenol (0.5, 1.0, 2.0 and 4.0 μg) during AF. Both atrioventricular nodal and accessory pathway conductions were enhanced proportional to isoproterenol dose. Isoproterenol had a greater effect on the atrioventricular node, as reflected by significantly greater changes in the shortest RR between normal complexes (339 ± 70 vs 255 ±21 ms, mean ± standard deviation, p > 0.001) than the shortest RR between preexcited complexes (264 ± 39 vs 219 ± 34 ms, p > 0.001) and a decrease in percentage of preexcited complexes (65 ± 37 vs 50 ± 33%, p > 0.01). After isoproterenol, 67% of patients had a shortest RR between preexcited complexes ≤ 250 ms, the traditional marker of risk for ventricular fibrillation, versus 33% in the control state. These results suggest that isoproterenol predictably accelerates the ventricular response in patients with asymptomatic WPW syndrome primarily by enhancement of atrioventricular nodal conduction. 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Klein, MD, University Hospital, P.O. Box 5339, Station A, London, Ontario, Canada N6A 5A5.</note><note type="biography">Dr. Klein is a career investigator of the Heart and Stroke Foundation of Ontario.</note><affiliation>Address for reprints: George J. Klein, MD, University Hospital, P.O. Box 5339, Station A, London, Ontario, Canada N6A 5A5.</affiliation><affiliation>Dr. Klein is a career investigator of the Heart and Stroke Foundation of Ontario.</affiliation><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation></author><author><persName><forename type="first">Arjun D.</forename><surname>Sharma</surname></persName><roleName type="degree">MD</roleName><note type="biography">Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</note><affiliation>Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</affiliation><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation></author><author><persName><forename type="first">Raymond</forename><surname>Yee</surname></persName><roleName type="degree">MD</roleName><note type="biography">Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</note><affiliation>Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</affiliation><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation></author><author><persName><forename type="first">Simon</forename><surname>Milstein</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation></author></analytic><monogr><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="pISSN">0002-9149</idno><idno type="PII">S0002-9149(00)X0715-1</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1988"></date><biblScope unit="volume">63</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="187">187</biblScope><biblScope unit="page" to="192">192</biblScope></imprint></monogr><idno type="istex">E5AC313F85EE082493CF4D674CCB88FF1011D1D1</idno><idno type="DOI">10.1016/0002-9149(89)90283-X</idno><idno type="PII">0002-9149(89)90283-X</idno><idno type="ArticleID">8990283X</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1989</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The asymptomatic individual with a Wolff-Parkinson-White (WPW) pattern is considered at risk for ventricular fibrillation if a rapid ventricular response (shortest RR interval ≤ 250 ms) is observed during induced atrial fibrillation (AF) in the laboratory. It has been suggested that isoproterenol administration during AF may more accurately define the patient at risk. Consequently, the effect of isoproterenol on ventricular response during AF was studied in 21 asymptomatic individuals with WPW pattern to assess the potential of isoproterenol to identify patients at risk for sudden death. An electrophysiologic study that included elective induction of AF was performed. The shortest and mean RR intervals between 2 consecutive preexcited and normal QRS complexes, the average RR interval and the proportion of preexcited QRS complexes were measured in the control state and after bolus injections of isoproterenol (0.5, 1.0, 2.0 and 4.0 μg) during AF. Both atrioventricular nodal and accessory pathway conductions were enhanced proportional to isoproterenol dose. Isoproterenol had a greater effect on the atrioventricular node, as reflected by significantly greater changes in the shortest RR between normal complexes (339 ± 70 vs 255 ±21 ms, mean ± standard deviation, p < 0.001) than the shortest RR between preexcited complexes (264 ± 39 vs 219 ± 34 ms, p < 0.001) and a decrease in percentage of preexcited complexes (65 ± 37 vs 50 ± 33%, p < 0.01). After isoproterenol, 67% of patients had a shortest RR between preexcited complexes ≤ 250 ms, the traditional marker of risk for ventricular fibrillation, versus 33% in the control state. These results suggest that isoproterenol predictably accelerates the ventricular response in patients with asymptomatic WPW syndrome primarily by enhancement of atrioventricular nodal conduction. Shortening of the shortest RR interval between preexcited complexes to 250 ms occurred in 67% of patients and would be expected to have poor specificity as a potential prognosticator of ventricular fibrillation.</p></abstract><textClass><keywords scheme="keyword"><list><head>Article category</head><item><term>Arrhythmias and conduction disturbances</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1988-09-14">Registration</change><change when="1988">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>AJC</jid><aid>8990283X</aid><ce:pii>0002-9149(89)90283-X</ce:pii><ce:doi>10.1016/0002-9149(89)90283-X</ce:doi><ce:copyright type="unknown" year="1989"></ce:copyright><ce:doctopics><ce:doctopic><ce:text>Arrhythmias and conduction disturbances</ce:text></ce:doctopic></ce:doctopics></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>This study was supported by a grant-in-aid from the Heart and Stroke Foundation of Ontario, Toronto, Ontario, Canada.</ce:note-para></ce:article-footnote><ce:title>Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern</ce:title><ce:author-group><ce:author><ce:given-name>Tibor S.</ce:given-name><ce:surname>Szabo</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>George J.</ce:given-name><ce:surname>Klein</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="COR1"><ce:sup loc="post">∗</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup loc="post">1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Arjun D.</ce:given-name><ce:surname>Sharma</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="FN2"><ce:sup loc="post">2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Raymond</ce:given-name><ce:surname>Yee</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="FN2"><ce:sup loc="post">2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Simon</ce:given-name><ce:surname>Milstein</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:affiliation><ce:textfn>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for reprints: George J. Klein, MD, University Hospital, P.O. Box 5339, Station A, London, Ontario, Canada N6A 5A5.</ce:text></ce:correspondence><ce:footnote id="FN1"><ce:label>1</ce:label><ce:note-para>Dr. Klein is a career investigator of the Heart and Stroke Foundation of Ontario.</ce:note-para></ce:footnote><ce:footnote id="FN2"><ce:label>2</ce:label><ce:note-para>Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</ce:note-para></ce:footnote></ce:author-group><ce:date-received day="13" month="6" year="1988"></ce:date-received><ce:date-accepted day="14" month="9" year="1988"></ce:date-accepted><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0010">The asymptomatic individual with a Wolff-Parkinson-White (WPW) pattern is considered at risk for ventricular fibrillation if a rapid ventricular response (shortest RR interval ≤ 250 ms) is observed during induced atrial fibrillation (AF) in the laboratory. It has been suggested that isoproterenol administration during AF may more accurately define the patient at risk. Consequently, the effect of isoproterenol on ventricular response during AF was studied in 21 asymptomatic individuals with WPW pattern to assess the potential of isoproterenol to identify patients at risk for sudden death. An electrophysiologic study that included elective induction of AF was performed. The shortest and mean RR intervals between 2 consecutive preexcited and normal QRS complexes, the average RR interval and the proportion of preexcited QRS complexes were measured in the control state and after bolus injections of isoproterenol (0.5, 1.0, 2.0 and 4.0 μg) during AF. Both atrioventricular nodal and accessory pathway conductions were enhanced proportional to isoproterenol dose. Isoproterenol had a greater effect on the atrioventricular node, as reflected by significantly greater changes in the shortest RR between normal complexes (339 ± 70 vs 255 ±21 ms, mean ± standard deviation, p < 0.001) than the shortest RR between preexcited complexes (264 ± 39 vs 219 ± 34 ms, p < 0.001) and a decrease in percentage of preexcited complexes (65 ± 37 vs 50 ± 33%, p < 0.01). After isoproterenol, 67% of patients had a shortest RR between preexcited complexes ≤ 250 ms, the traditional marker of risk for ventricular fibrillation, versus 33% in the control state. These results suggest that isoproterenol predictably accelerates the ventricular response in patients with asymptomatic WPW syndrome primarily by enhancement of atrioventricular nodal conduction. Shortening of the shortest RR interval between preexcited complexes to 250 ms occurred in 67% of patients and would be expected to have poor specificity as a potential prognosticator of ventricular fibrillation.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Usefulness of isoproterenol during atrial fibrillation in evaluation of asymptomatic Wolff-Parkinson-White pattern</title></titleInfo><name type="personal"><namePart type="given">Tibor S.</namePart><namePart type="family">Szabo</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">George J.</namePart><namePart type="family">Klein</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation><description>Address for reprints: George J. Klein, MD, University Hospital, P.O. Box 5339, Station A, London, Ontario, Canada N6A 5A5.</description><description>Dr. Klein is a career investigator of the Heart and Stroke Foundation of Ontario.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Arjun D.</namePart><namePart type="family">Sharma</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation><description>Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Raymond</namePart><namePart type="family">Yee</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation><description>Drs. Sharma and Yee are Ontario Ministry of Health career scientists.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Simon</namePart><namePart type="family">Milstein</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Arrhythmia Service, Cardiac Investigation Unit, University Hospital, London, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1988</dateIssued><dateValid encoding="w3cdtf">1988-09-14</dateValid><copyrightDate encoding="w3cdtf">1989</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The asymptomatic individual with a Wolff-Parkinson-White (WPW) pattern is considered at risk for ventricular fibrillation if a rapid ventricular response (shortest RR interval ≤ 250 ms) is observed during induced atrial fibrillation (AF) in the laboratory. It has been suggested that isoproterenol administration during AF may more accurately define the patient at risk. Consequently, the effect of isoproterenol on ventricular response during AF was studied in 21 asymptomatic individuals with WPW pattern to assess the potential of isoproterenol to identify patients at risk for sudden death. An electrophysiologic study that included elective induction of AF was performed. The shortest and mean RR intervals between 2 consecutive preexcited and normal QRS complexes, the average RR interval and the proportion of preexcited QRS complexes were measured in the control state and after bolus injections of isoproterenol (0.5, 1.0, 2.0 and 4.0 μg) during AF. Both atrioventricular nodal and accessory pathway conductions were enhanced proportional to isoproterenol dose. Isoproterenol had a greater effect on the atrioventricular node, as reflected by significantly greater changes in the shortest RR between normal complexes (339 ± 70 vs 255 ±21 ms, mean ± standard deviation, p < 0.001) than the shortest RR between preexcited complexes (264 ± 39 vs 219 ± 34 ms, p < 0.001) and a decrease in percentage of preexcited complexes (65 ± 37 vs 50 ± 33%, p < 0.01). After isoproterenol, 67% of patients had a shortest RR between preexcited complexes ≤ 250 ms, the traditional marker of risk for ventricular fibrillation, versus 33% in the control state. These results suggest that isoproterenol predictably accelerates the ventricular response in patients with asymptomatic WPW syndrome primarily by enhancement of atrioventricular nodal conduction. Shortening of the shortest RR interval between preexcited complexes to 250 ms occurred in 67% of patients and would be expected to have poor specificity as a potential prognosticator of ventricular fibrillation.</abstract><note>This study was supported by a grant-in-aid from the Heart and Stroke Foundation of Ontario, Toronto, Ontario, Canada.</note><subject><genre>Article category</genre><topic>Arrhythmias and conduction disturbances</topic></subject><relatedItem type="host"><titleInfo><title>The American Journal of Cardiology</title></titleInfo><titleInfo type="abbreviated"><title>AJC</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">19890115</dateIssued></originInfo><identifier type="ISSN">0002-9149</identifier><identifier type="PII">S0002-9149(00)X0715-1</identifier><part><date>19890115</date><detail type="volume"><number>63</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>155</start><end>262</end></extent><extent unit="pages"><start>187</start><end>192</end></extent></part></relatedItem><identifier type="istex">E5AC313F85EE082493CF4D674CCB88FF1011D1D1</identifier><identifier type="DOI">10.1016/0002-9149(89)90283-X</identifier><identifier type="PII">0002-9149(89)90283-X</identifier><identifier type="ArticleID">8990283X</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><enrichments><istex:refBibTEI uri="https://api.istex.fr/document/E5AC313F85EE082493CF4D674CCB88FF1011D1D1/enrichments/refBib"><teiHeader></teiHeader><text><front></front><body></body><back><listBibl><biblStruct><analytic><title level="a" type="main">A long-term follow up of 41 cases</title><author><persName><forename type="first">E</forename><surname>Flensted-Jensen</surname></persName></author><author><persName><forename 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