Advertisement

Cardiac Pacing pp 755-766 | Cite as

Effects of Intravenous Amiodarone on Refractory Periods of the His Purkinje System

  • Beatrice Perrot
  • D. Zallot
  • N. Danchin
  • F. Cherrier
  • G. Faivre
Conference paper

Summary

In 4 patients an intrahisian second degree AV block occurred during oral amiodarone (Am) therapy (daily dose of 400 mg) and disappeared 3 months after the end of Am. To assess a relation between Am and intrahisian A V block, 150 mg of Am were injected in 26 patients (pts) with prolonged HV interval and/or infrahisian block induced by programmed atrial (A) extrastimulus technique. His Purkinje anterograde effective refractory period (HP ERP) was the longest HI H2 interval in which conduction to the ventricles failed to occur (H1 = His bundle electrogram of the A paced rhythm, H2: His bundle electrogram after the extrastimulus); HP functional RP (HP FRP) was the shortest propagated V1-V2 interval and HP relative RP (HP RRP) was the longest HI H2 interval with H2-V2 > H1-V1. The HP RP were studied before and after Am at the same A paced rhythm. HP-RP increased (2 to 12%) in 9pts; HP-AV-conduction was abnormal (spontaneous HV interval > 55 ms, HV interval after Ajmaline ≥ 100 ms, intrahisian second degree A V block during A pacing a rate ≤ 150 b/min) in 6 pts. HP-RP could not be calculated in 8 pts: an AV nodal block occurred after inj. of Am. The HP-A V -conduction was normal in these pts. HP RP were identical in 7 pts, shorter in 2 pts. In these pts the HP-A V -conduction was normal.

In conclusion, intravenous Am lengthened HP RP in 9 pts out of 26 (34%). This effect was more frequent in pts with abnormal HP-A V -conduction. Am should be used with carefulness in pts with abnormalities of HP-conduction. The occurrence of a second or third degree A V block with normal QRS during oral Am therapy indicates an electrophysiological study to determine the level of the block which might be within A V node or HP system.

Keywords

Cycle Length Refractory Period Atrial Pace Effective Refractory Period Wolff Parkinson White Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Podrid P, Lown B: Amiodarone therapy in symptomatic sustained refractory atrial and ventricular tachyarrhythmias. Am Heart J 1981; 101: 374–379.CrossRefPubMedGoogle Scholar
  2. 2.
    Rowland E, Krikler D: Electrophysiological assessment of amiodarone in treatment of resistant supraventricular arrhythmias. Br Heart J 1980; 44: 82–90.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ward DE, Camm AJ, Spurrell RAJ; Clinical antiarrhythmic effects of amiodarone in patients with resistant paroxysmal tachycardias. Br Heart J 1980; 44: 91–95.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rotmensch H, Belhassen B, Ferguson R: Amiodarone - Benefits and risks in perspective. Am Heart J 1982; 104: 1117–1119.CrossRefPubMedGoogle Scholar
  5. 5.
    Wellens H, Brugada P, Roy D, Heddle B, Bar F: A comparison for the electro physiological effects of intravenous and oral amiodarone. Am J Cardiol 1982; 49: 1043.CrossRefGoogle Scholar
  6. 6.
    Derrida JP, Chiche P: Pharmacocinetique des principaux antiarythmiques. Coeur Med Int 1978; 17: 79–88.Google Scholar
  7. 7.
    Sebag C, Motte G: Mécanismes d’action cellulaire des medicaments antiarythmiques. Coeur Med Int 1978; 17: 509–519.Google Scholar
  8. 8.
    Vaughan Williams EM: Intérêt des etudes expérimentales d’antiarythmiques et leur application clinique. Coeur Med Int 1978; 17: 471–489.Google Scholar
  9. 9.
    Puech P, Cabasson J, Mellet JP, Guimond L, Bachy C, Massine A: Analyse des effects électrophysiologiques de I’amiodarone par l’enregistrement simultané des potentiels d’action monophasique et du faisceau de His. Colloque sur l’amiodarone, Paris, nov 1977: 18–21.Google Scholar
  10. 10.
    Touboul P, Attalah G, Gressard A, Michelon G, Chatelain MT, Delahaye JP: Effets électrophysiologiques des agents antiarythmiques chez I’homme. Tentative de classification. Arch Mal Coeur 1978: 72–81.Google Scholar
  11. 11.
    Touboul P, Huerta F, Porte J, Delahaye JP: Bases électrophysiologiques de l’action anitarythmique de I’amiodarone chez l’homme. Arch Mal Coeur 1976; 69: 845–853.PubMedGoogle Scholar
  12. 12.
    Touboul P, Porte J, Huerta F, Delahaye JP: Electrophysiological effects of amiodarone in man. Am J Cardiol 1975; 35: 173.CrossRefGoogle Scholar
  13. 13.
    Frank R, Fontaine G, Grosgogeat Y: Etude de l’effet antiarythmique de I’amiodarone per os par les méthodes provocatives. Colloque sur I’amiodarone, Paris, Nov 1977: 35–42.Google Scholar
  14. 14.
    Finerman W, Hamer A, Peter T, Weiss D, Mandel W: Electrophysiologic effects of chronic amiodarone therapy in patients with ventricular arrhythmias. Am Heart 1 1982; 104: 987–995.CrossRefGoogle Scholar
  15. 15.
    Rosenbaum MB, Chiale PA, Halpern MS, Nau GJ, Przybylski J, Levi RJ, Lazzari JO, Elizari MV: Clinical efficacy of amiodarone as an antiarrhythmic agent. Am J Cardiol 1976; 38: 934–944.CrossRefPubMedGoogle Scholar
  16. 16.
    Fauchier JP, Brochier M, Raynaud R: Etude clinique des effets antiarythmiques ventriculaires de I’amiodarone (orale ou injectable). Ann Cardiol Angeiol 1973; 22: 427–435.Google Scholar
  17. 17.
    Marcus F, Fontaine G, Frank R, Grosgogeat Y: Clinical pharmacology and therapeutic applications of the antiarrhythmic agent, amiodarone. Am Heart 1 1981; 101: 480–493.CrossRefGoogle Scholar
  18. 18.
    Perrot B, Cherrier F, Faivre G: Valeurs de la période réfractaire antérograde effective du faisceau de His. Arch Mal Coeur 1981; 74: 381–389.PubMedGoogle Scholar
  19. 19.
    Denes P, Wu D, Dhingra R, Pietras R, Rosen K: The effects of cycle length on cardiac refractory periods in man. Circulation 1974; 49: 32–41.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1983

Authors and Affiliations

  • Beatrice Perrot
    • 1
  • D. Zallot
  • N. Danchin
  • F. Cherrier
  • G. Faivre
  1. 1.Cardiologie chu BrabuisVandoeuvreFrance

Personalised recommendations