Use of transesophageal left atrial cardiac pacing for assessment of cordarone effectiveness in patients with atrioventricular tachycardia

• Published in: Terapevtic̆eskii arhiv Vol. 70; no. 6; p. 47
• Main Authors: Matiushin, G V, Shul'man, V A, Balog, A I, Golovenkin, S E, Bezruk, A P, Ivanitskiĭ, E A, Smirnova, O V
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 1998
• Subjects: Adult; Amiodarone - administration & dosage; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - therapeutic use; Cardiac Pacing, Artificial - methods; Drug Administration Schedule; Electrocardiography; Esophagus; Female; Follow-Up Studies; Heart Atria - physiopathology; Humans; Male; Tachycardia, Atrioventricular Nodal Reentry - drug therapy; Tachycardia, Atrioventricular Nodal Reentry - physiopathology; Treatment Outcome; Wolff-Parkinson-White Syndrome - drug therapy; Wolff-Parkinson-White Syndrome - physiopathology
• ISSN: 0040-3660

To assess by means of transesophageal left atrial pacing the effectiveness of cordarone treatment for arrhythmias caused by re-entry mechanism.
Effectiveness of cordarone treatment was estimated in 25 patients with atrioventricular nodal tachycardia (AVNT) and in 33 patients with WPW syndrome and reciprocal atrioventricular tachycardia (RAVT) with frequent paroxysms of tachycardia 1-5 times per week. Transesophageal left atrial pacing (TELAP) was performed before antiarrhythmic treatment and on cordarone treatment day 14-18. Cordarone was given for two months in common regimen (the first 10 days--600 mg/day, the next 10 days--400 mg/day and then 200 mg/day).
The first TELAP induced paroxysmal AVNT or RAVT in all the patients. According to the results of the second TELAP, all the patients were divided into three groups. Group 1 included 28 patients in whom the second TELAP was unable to induce tachycardia. All these patients had increased effective refractory period (ERP) of AV node and/or of accessory pathway (AP) values and a decreased Wenkebach point (WP) < 150/min during the second TELAP in comparison with the first TELAP. All these patients had no spontaneous paroxysms of T during the 3-month follow-up. Group 2 included 18 patients in whom the second TELAP induced AVT lasting < 30 seconds. 16 of these patients had tachycardia with less heart rate during the second TELAP in comparison with the first TELAP, 153 + (-) 8 bpm vs 188 + (-) 10 bpm, p < 0.001, respectively. Also, in these 16 patients we found an increase of values of ERP of AV node and/or AP > 360 ms and a decrease of WP < 150 bmp. 14 of these 16 patients had no spontaneous paroxysms of AVT and 2 patients had short episodes of AVT during the 3-month follow-up with effects of vagal manoeuvers. From 2 other patients of group 2 one had short episodes of spontaneous T and one had long episodes of tachycardia with effect of verapamil i.v. Group 3 included 12 patients in whom the second TELAP induced the same AVT as the first TELAP. Values of ERP of AV node and/or AP and WP during the first and second TELAP were not different. All of these patients had long spontaneous paroxysms of AVT during cordarone treatment day 14-18. The treatment was discontinued in all patients of group 3.
Cordarone is effective in prevention of AVT. Negative results in provocation of AVT during TELAP after 14-18 days of cordarone treatment is a very specific predictor of cordarone treatment effectiveness. Provocation by TELAP of short episodes of AVT with reduced heart rate and higher values of ERP of AV node and AP and lowering of WP < 150 bpm may not predict ineffectiveness of cordarone in patients with AVT. Moreover, the majority of these patients had no spontaneous episodes of AVT. Provocation by TELAP during cordarone treatment of the same AVT episodes as before cordarone treatment is a very specific predictor of cordarone effectiveness.