• Title of article

    Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia

  • Author/Authors

    Paolo Alboni، نويسنده , , Corrado Tomasi، نويسنده , , Carlo Menozzi، نويسنده , , Nicola Bottoni، نويسنده , , Nelly Paparella، نويسنده , , Giuseppe Fuca، نويسنده , , Michele Brignole، نويسنده , , Riccardo Cappato، نويسنده ,

  • Issue Information
    روزنامه با شماره پیاپی سال 2001
  • Pages
    6
  • From page
    548
  • To page
    553
  • Abstract
    OBJECTIVES We tested the efficacy of two drug treatments, flecainide (F) and the combination of diltiazem and propranolol (D/P), administered as a single oral dose for termination of the arrhythmic episodes. BACKGROUND Both prophylactic drug therapy and catheter ablation are questionable as first-line treatments in patients with infrequent and well-tolerated episodes of paroxysmal supraventricular tachycardia (SVT). METHODS Among 42 eligible patients (13% of all screened for SVT) with infrequent (≤5/year), well-tolerated and long-lasting episodes, 37 were enrolled and 33 had SVT inducible during electrophysiological study. In the latter, three treatments (placebo, F, and D/P) were administered in a random order 5 min after SVT induction on three different days. RESULTS Conversion to sinus rhythm occurred within 2 h in 52%, 61%, and 94% of patients on placebo, F and D/P, respectively (p < 0.001). The conversion time was shorter after D/P (32 ± 22 min) than after placebo (77 ± 42 min, p < 0.001) or F (74 ± 37 min, p < 0.001). Four patients (1 placebo, 1 D/P, and 2 F) had hypotension and four (3 D/P and 1 F) a sinus rate <50 beats/min following SVT interruption. Patients were discharged on a single oral dose of the most effective drug treatment (F or D/P) at time of acute testing. Twenty-six patients were discharged on D/P and five on F. During 17 ± 12 months follow-up, the treatment was successful in 81% of D/P patients and in 80% of F patients, as all the arrhythmic episodes were interrupted out-of-hospital within 2 h. In the remaining patients, a failure occurred during one or more episodes because of drug ineffectiveness or drug unavailability. One patient had syncope after D/P ingestion. During follow-up, the percentage of patients calling for emergency room assistance was significantly reduced as compared to the year before enrollment (9% vs. 100%, p < 0.0001). CONCLUSIONS The episodic treatment with oral D/P and F, as assessed during acute testing, appears effective in the management of selected patients with SVT. This therapeutic strategy minimizes the need for emergency room admissions during tachycardia recurrences.
  • Keywords
    ECG , f , supraventricular tachycardia , SVT , AV , atrioventricular , D/P , diltiazem and propranolol , Electrocardiogram , Flecainide
  • Journal title
    JACC (Journal of the American College of Cardiology)
  • Serial Year
    2001
  • Journal title
    JACC (Journal of the American College of Cardiology)
  • Record number

    596393