Electropharmacologic effects of class I and class III antiarrhythmia drugs on typical atrial flutter: Insights into the mechanism of termination

Ching Tai Tai, Shih Ann Chen, An Ning Feng, Wen Chung Yu, Yi Jen Chen, Mau Song Chang

研究成果: 雜誌貢獻文章同行評審

51 引文 斯高帕斯(Scopus)

摘要

Background - Acute effects of class I and class III antiarrhythmia drugs on the reentrant circuit of typical atrial flutter are not fully studied. Furthermore, the critical electrophysiologic determinants of flutter termination by antiarrhythmia drugs are not clear. Methods and Results - The study population consisted of 36 patients (mean age, 53±17 years) with clinically documented typical atrial flutter. A 20-pole 'halo' catheter was positioned around the tricuspid annulus. Incremental pacing was performed to measure the conduction velocity along the isthmus and lateral wall, and extrastimulation was performed to evaluate atrial refractory period in the baseline state and after intravenous infusion of ibutilide, propafenone, and amiodarone. Efficacy of these drugs in conversion of typical atrial flutter and patterns of termination were also determined. Ibutilide significantly increased the atrial refractory period and decreased conduction velocity in the isthmus at short pacing cycle length. It terminated atrial flutter in 8 (67%) of 12 patients after prolongation of flutter cycle length due to increase (86±19%) of conduction time in the isthmus. Propafenone predominantly decreased conduction velocity with use dependency and significantly increased atrial refractory period, but it only converted atrial flutter in 4 (33%) of 12 patients. Amiodarone had fewer effects on atrial refractory period and conduction velocity than did ibutilide and propafenone, and it terminated atrial flutter in only 4 (33%) of 12 patients. Termination of typical atrial flutter was due to failure of wave front propagation through the isthmus, which occurred with cycle length oscillation, abruptly without variability of cycle length, or after premature activation of the reentrant circuit. Conclusions - Ibutilide, with a unique increase in atrial refractoriness, was more effective in conversion of atrial flutter than were propafenone and amiodarone.
原文英語
頁(從 - 到)1935-1945
頁數11
期刊Circulation
97
發行號19
DOIs
出版狀態已發佈 - 五月 19 1998
對外發佈Yes

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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