Intravenous diltiazem for termination of reentrant supraventricular tachycardia: a placebo-controlled, randomized, double-blind, multicenter study

• Published in: Journal of the American College of Cardiology Vol. 13; no. 3; pp. 538 - 544
• Main Authors: Huycke, Edward C, Sung, Ruey J, Dias, Virgil C, Milstein, Simon, Hariman, Robert J, Platia, Edward V
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-1989; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Antiarythmic agents; Biological and medical sciences; Cardiovascular system; Diltiazem - administration & dosage; Diltiazem - adverse effects; Double-Blind Method; Electrocardiography; Female; Heart Conduction System - drug effects; Hemodynamics - drug effects; Humans; Injections, Intravenous; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Random Allocation; Tachycardia, Supraventricular - drug therapy; Wolff-Parkinson-White Syndrome - drug therapy; Therapeutic efficiency; Human; Intravenous administration; Reentry; Arrhythmia; Multicenter study; Calcium antagonist; Electrophysiology; Cardiovascular disease; Paroxysmal supraventricular tachycardia; Chemotherapy; Treatment; Double blind study; Antiarrhythmia agent
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(89)90589-5

To assess the efficacy and safety of intravenous diltiazem, 54 patients with inducible sustained supraventricular tachycardia received diltiazem, 0.25 mg/kg or 0.25 mg/kg, followed by 0.35 mg/kg body weight, or placebo in a double-blind, randomized study. Twenty patients had atrioventricular (AV) node reentrant tachycardia, whereas 34 had orthodromic AV reciprocating tachycardia associated with the Wolfl-Parkinson-White syndrome. Supraventricular tachycardia was terminated in 24 (86%) of 28 patients given intravenous diltiazem compared with 5 (19%) of 26 given placebo (p = 0.0000014). Nineteen (95%) of 20 patients initially given placebo had termination of supraventricular tachycardia after receiving diltiazem. Overall, 43 (90%) of 48 patients receiving intravenous diltiazem had conversion of supraventricular tachycardia to sinus rhythm; the median time to tachycardia termination was 2 min after initiation of a 2 min diltiazem infusion.
All 20 patients (100%) with AV node reentrant tachycardia treated with diltiazem had conversion of tachycardia to sinus rhythm as did 26 (81%) of 30 patients with AV reciprocating tachycardia treated with diltiazem. Diltiazem prolonged refractoriness and slowed conduction of the AV node and thereby provided antiarrhythmic action to cause tachycardia termination. Diltiazem had no effect on the electrophysiologic properties of accessory AV connections. Adverse effects were seen in 3 (6%) of the 48 patients given diltiazem.
For paroxysmal supraventricular tachycardia initiated in the electrophysiology laboratory, it is concluded that intravenous diltiazem is safe and very effective for acute tachycardia termination when the AV node is part of the reentrant circuit.