Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome
Identifieur interne : 000258 ( Main/Corpus ); précédent : 000257; suivant : 000259Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome
Auteurs : Mohammad Shenasa ; Martin Fromer ; Gerard Faugere ; Reginald Nadeau ; Robert A. Leblanc ; Chantal Lambert ; Mohammad Ali Sadr-AmeliSource :
- The American Journal of Cardiology [ 0002-9149 ] ; 1986.
Abstract
The electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p < 0.001]; and oral, 377 ± 33 ms [p < 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p < 0.005) and 225 ± 33 ms with oral administration (p < 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p < 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p < 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.
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DOI: 10.1016/0002-9149(87)90803-4
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome</title><author><name sortKey="Shenasa, Mohammad" sort="Shenasa, Mohammad" uniqKey="Shenasa M" first="Mohammad" last="Shenasa">Mohammad Shenasa</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Fromer, Martin" sort="Fromer, Martin" uniqKey="Fromer M" first="Martin" last="Fromer">Martin Fromer</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Faugere, Gerard" sort="Faugere, Gerard" uniqKey="Faugere G" first="Gerard" last="Faugere">Gerard Faugere</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Nadeau, Reginald" sort="Nadeau, Reginald" uniqKey="Nadeau R" first="Reginald" last="Nadeau">Reginald Nadeau</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Leblanc, Robert A" sort="Leblanc, Robert A" uniqKey="Leblanc R" first="Robert A." last="Leblanc">Robert A. Leblanc</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lambert, Chantal" sort="Lambert, Chantal" uniqKey="Lambert C" first="Chantal" last="Lambert">Chantal Lambert</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Sadr Ameli, Mohammad Ali" sort="Sadr Ameli, Mohammad Ali" uniqKey="Sadr Ameli M" first="Mohammad Ali" last="Sadr-Ameli">Mohammad Ali Sadr-Ameli</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:6C3FF9C71D9A93E8FE8655F2752175528585932C</idno><date when="1987" year="1987">1987</date><idno type="doi">10.1016/0002-9149(87)90803-4</idno><idno type="url">https://api.istex.fr/document/6C3FF9C71D9A93E8FE8655F2752175528585932C/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000258</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome</title><author><name sortKey="Shenasa, Mohammad" sort="Shenasa, Mohammad" uniqKey="Shenasa M" first="Mohammad" last="Shenasa">Mohammad Shenasa</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Fromer, Martin" sort="Fromer, Martin" uniqKey="Fromer M" first="Martin" last="Fromer">Martin Fromer</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Faugere, Gerard" sort="Faugere, Gerard" uniqKey="Faugere G" first="Gerard" last="Faugere">Gerard Faugere</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Nadeau, Reginald" sort="Nadeau, Reginald" uniqKey="Nadeau R" first="Reginald" last="Nadeau">Reginald Nadeau</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Leblanc, Robert A" sort="Leblanc, Robert A" uniqKey="Leblanc R" first="Robert A." last="Leblanc">Robert A. Leblanc</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lambert, Chantal" sort="Lambert, Chantal" uniqKey="Lambert C" first="Chantal" last="Lambert">Chantal Lambert</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Sadr Ameli, Mohammad Ali" sort="Sadr Ameli, Mohammad Ali" uniqKey="Sadr Ameli M" first="Mohammad Ali" last="Sadr-Ameli">Mohammad Ali Sadr-Ameli</name><affiliation><mods:affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, 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="1986">1986</date><biblScope unit="volume">59</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="301">301</biblScope><biblScope unit="page" to="306">306</biblScope></imprint><idno type="ISSN">0002-9149</idno></series><idno type="istex">6C3FF9C71D9A93E8FE8655F2752175528585932C</idno><idno type="DOI">10.1016/0002-9149(87)90803-4</idno><idno type="PII">0002-9149(87)90803-4</idno><idno type="ArticleID">87908034</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 electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p < 0.001]; and oral, 377 ± 33 ms [p < 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p < 0.005) and 225 ± 33 ms with oral administration (p < 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p < 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p < 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Mohammad Shenasa MD, PhD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Martin Fromer MD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Gerard Faugere MD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Reginald Nadeau MD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Robert A. Leblanc PhD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Chantal Lambert PhD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Mohammad Ali Sadr-Ameli MD</name><affiliations><json:string>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, 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>87908034</json:string></articleId><language><json:string>eng</json:string></language><abstract>The electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p > 0.001]; and oral, 377 ± 33 ms [p > 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p > 0.005) and 225 ± 33 ms with oral administration (p > 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p > 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p > 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.</abstract><qualityIndicators><score>6.108</score><pdfVersion>1.3</pdfVersion><pdfPageSize>554 x 770 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PhD, Clinical Electrophysiology Laboratory, Sacre-Coeur Hospital, 5400 Gouin West, Montreal, Quebec, Canada H4J 1C5.</affiliation><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation></author><author><persName><forename type="first">Martin</forename><surname>Fromer</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation></author><author><persName><forename type="first">Gerard</forename><surname>Faugere</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation></author><author><persName><forename type="first">Reginald</forename><surname>Nadeau</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation></author><author><persName><forename type="first">Robert A.</forename><surname>Leblanc</surname></persName><roleName type="degree">PhD</roleName><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation></author><author><persName><forename type="first">Chantal</forename><surname>Lambert</surname></persName><roleName type="degree">PhD</roleName><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation></author><author><persName><forename type="first">Mohammad Ali</forename><surname>Sadr-Ameli</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, 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)X0964-2</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1986"></date><biblScope unit="volume">59</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="301">301</biblScope><biblScope unit="page" to="306">306</biblScope></imprint></monogr><idno type="istex">6C3FF9C71D9A93E8FE8655F2752175528585932C</idno><idno type="DOI">10.1016/0002-9149(87)90803-4</idno><idno type="PII">0002-9149(87)90803-4</idno><idno type="ArticleID">87908034</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1987</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p < 0.001]; and oral, 377 ± 33 ms [p < 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p < 0.005) and 225 ± 33 ms with oral administration (p < 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p < 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p < 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.</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="1986-07-28">Registration</change><change when="1986-07-25">Modified</change><change when="1986">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>87908034</aid><ce:pii>0002-9149(87)90803-4</ce:pii><ce:doi>10.1016/0002-9149(87)90803-4</ce:doi><ce:copyright type="unknown" year="1987"></ce:copyright><ce:doctopics><ce:doctopic><ce:text>Arrhythmias and conduction disturbances</ce:text></ce:doctopic></ce:doctopics></item-info><head><ce:title>Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome</ce:title><ce:author-group><ce:author><ce:given-name>Mohammad</ce:given-name><ce:surname>Shenasa</ce:surname><ce:degrees>MD, PhD</ce:degrees><ce:cross-ref refid="COR1"><ce:sup loc="post">∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Martin</ce:given-name><ce:surname>Fromer</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Gerard</ce:given-name><ce:surname>Faugere</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Reginald</ce:given-name><ce:surname>Nadeau</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Robert A.</ce:given-name><ce:surname>Leblanc</ce:surname><ce:degrees>PhD</ce:degrees></ce:author><ce:author><ce:given-name>Chantal</ce:given-name><ce:surname>Lambert</ce:surname><ce:degrees>PhD</ce:degrees></ce:author><ce:author><ce:given-name>Mohammad Ali</ce:given-name><ce:surname>Sadr-Ameli</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:affiliation><ce:textfn>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for reprints: Mohammad Shenasa, MD, PhD, Clinical Electrophysiology Laboratory, Sacre-Coeur Hospital, 5400 Gouin West, Montreal, Quebec, Canada H4J 1C5.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="4" month="6" year="1986"></ce:date-received><ce:date-revised day="25" month="7" year="1986"></ce:date-revised><ce:date-accepted day="28" month="7" year="1986"></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 electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p < 0.001]; and oral, 377 ± 33 ms [p < 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p < 0.005) and 225 ± 33 ms with oral administration (p < 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p < 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p < 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome</title></titleInfo><name type="personal"><namePart type="given">Mohammad</namePart><namePart type="family">Shenasa</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation><description>Address for reprints: Mohammad Shenasa, MD, PhD, Clinical Electrophysiology Laboratory, Sacre-Coeur Hospital, 5400 Gouin West, Montreal, Quebec, Canada H4J 1C5.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martin</namePart><namePart type="family">Fromer</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gerard</namePart><namePart type="family">Faugere</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Reginald</namePart><namePart type="family">Nadeau</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert A.</namePart><namePart type="family">Leblanc</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chantal</namePart><namePart type="family">Lambert</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mohammad Ali</namePart><namePart type="family">Sadr-Ameli</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Clinical Electrophysiology Laboratory and Department of Medicine and the Research Center, Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, 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">1986</dateIssued><dateValid encoding="w3cdtf">1986-07-28</dateValid><dateModified encoding="w3cdtf">1986-07-25</dateModified><copyrightDate encoding="w3cdtf">1987</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 electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p < 0.001]; and oral, 377 ± 33 ms [p < 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p < 0.005) and 225 ± 33 ms with oral administration (p < 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p < 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p < 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.</abstract><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">19870201</dateIssued></originInfo><identifier type="ISSN">0002-9149</identifier><identifier type="PII">S0002-9149(00)X0964-2</identifier><part><date>19870201</date><detail type="volume"><number>59</number><caption>vol.</caption></detail><detail type="issue"><number>4</number><caption>no.</caption></detail><extent unit="issue pages"><start>203</start><end>392</end></extent><extent unit="pages"><start>301</start><end>306</end></extent></part></relatedItem><identifier type="istex">6C3FF9C71D9A93E8FE8655F2752175528585932C</identifier><identifier type="DOI">10.1016/0002-9149(87)90803-4</identifier><identifier type="PII">0002-9149(87)90803-4</identifier><identifier type="ArticleID">87908034</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><enrichments></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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