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The effect of intravenous disopyramide phosphate on recurrent paroxysmal tachycardias.

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.

Atrial Fibrillation

[Paroxysmal tachycardia due to a latent Wolff-Parkinson-White syndrome].

The authors studied 35 cases of Bouveret type paroxysmal tachycardia with normal baseline ECB, without any signs of Wolff-Parkinson-White syndrome. In more than half the patients, it seems that it may be stated that the paroxysmal tachycardia is related not to a reciprocal intranodal rhythm, as is said classically, but to a reciprocal rhythm using in the anterograde direction the normal pathways and in a retrograde direction a direct atrio-ventricular bundle in which only retrograde conduction is possible. This explains the absence of any patent preexcitation pattern on tracings in sinus rhythm. The authors particularly stress the value of a sign recorded at the onset of an attack of tachycardia: transient slowing of the rate of the tachycardia when functional bundle branch block is present can only be explained by the existence of a latent preexcitation bundle on the side of the "slowing bundle branch block".

Bundle-Branch Block

Paroxysmal supraventricular tachycardia induction in patients with Wolff-Parkinson-White syndrome.

In 54 patients with pre-excitation, 30 (56%) had inducible A-V re-entrant paroxysmal tachycardia. Of these 30, 20 had spontaneous paroxysmal tachycardia (four also had atrial fibrillation), four had spontaneous paroxysmal atrial fibrillation, five had a history of palpitation without arrhythmia, and one was asymptomatic. In 24 patients (44%), paroxysmal tachycardia was not inducible. Of these 24, none had documented paroxysmal tachycardia, four had atrial fibrillation, none had palpitation without arrhythmia, and 11 were asymptomatic. The incidence of documented paroxysmal tachycardia was higher in the patients with inducible tachycardia (P less than 0.001). Tachycardia induction was noted in 20 of 20 patients with spontaneous paroxysmal tachycardia, eight of 12 patients with paroxysmal atrial fibrillation, five of 14 patients with palpitation and no arrhythmia, and one of 12 asymptomatic patients. The frequency of ability to induce paroxysmal tachycardia was significantly higher in both the patients with documented spontaneous paroxysmal tachycardia and the patients with paroxysmal atrial fibrillation than in the asymptomatic group (P less than 0.01).

Adolescent

An unusual form of the bradycardia-tachycardia syndrome: paroxysmal A-V block and ventricular tachycardia.

An unusual case of alternating bradycardia-tachycardia, paroxysmal Mobitz II A-V block and ventricular tachycardia is described. The patient presented with a normal resting (control) electrocardiogram and intracardiac conduction times (A-H and H-V intervals). The clinical evaluation, electrophysiology, and importance of defining the cause of serious rhythm disturbances prior to therapy are discussed.

Bradycardia

Carotid sinus massage induced elimination of rate related bundle branch block during paroxysmal atrial tachycardia: a simple method of proving bypass tract participation in the tachycardia.

Four cases of paroxysmal atrial tachycardia are described in whom rate related left bundle branch block (LBBB) was often present which persisted indefintely and showed no signs of spontaneous disappearance. Transient slowing of the tachycardia by carotid sinus massage in each case eliminated LBBB and this led to tachycardia acceleration. The tachycardia acceleration was traceable to a shortening in ventriculoatrial conduction. These observations proved the participation of a left sided bypass tract in the tachycardia circuit in each of these cases.

Bundle-Branch Block

The relationship between posture, blood pressure and electrophysiological properties in patients with paroxysmal supraventricular tachycardia.

In 9 patients with paroxysmal supraventricular tachycardia the effects of tilting the body on the blood pressure and on responses during tachycardia or pacing revealed important effects that could influence the clinical presentation and the treatment required. Assessment of these reflex responses adds a major dimension to the understanding of the patient with supraventricular tachycardia.

Atrioventricular Node