PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jcinvestThe Journal of Clinical InvestigationCurrent IssueArchiveSubscriptionAbout the Journal
 
J Clin Invest. 1983 July; 72(1): 350–360.
PMCID: PMC1129190

Effects of verapamil on ventricular tachycardias possibly caused by reentry, automaticity, and triggered activity.

Abstract

To define the role of verapamil in the treatment of ventricular tachycardia (VT), we studied 21 patients with chronic recurrent VT. Electrophysiologic studies were performed before and during intravenous infusion of verapamil (0.15 mg/kg followed by 0.005 mg/kg per min). On the basis of the mode of VT initiation and termination, we identified three groups of patients: (a) 11 patients had VT suggestive of reentry, as VT could be initiated with ventricular extrastimulation and terminated with overdrive ventricular pacing. Verapamil did not affect the inducibility and cycle length of VT. (b) 7 patients had VT suggestive of catecholamine-sensitive automaticity as VT could not be initiated with programmed electrical stimulation but could be provoked by isoproterenol infusion. Moreover, the VT could not be converted to a sustained sinus rhythm with overdrive ventricular pacing and it resolved only with discontinuing isoproterenol infusion. Verapamil exerted no effects on VT. (c) 3 patients had VT with electrophysiologic characteristics suggestive of triggered activity related to delayed afterdepolarizations. Characteristically, after attaining a range of cycle lengths, the sinus, atrial or ventricular paced rhythm could initiate VT without ventricular extrastimulation. The first beat of VT invariably occurred late in the cardiac cycle with a premature coupling interval 0-80 ms shorter than the preceding QRS cycle length; the premature coupling interval gradually decreased as the sinus, atrial or ventricular paced cycle length progressively shortened. Of note, verapamil completely suppressed VT inducibility in these three patients. These observations lead us to suggest that verapamil does not affect VT caused by reentry and catecholamine-sensitive automaticity but is effective in suppressing VT caused by triggered activity related to delayed afterdepolarizations in humans.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Schamroth L, Krikler DM, Garrett C. Immediate effects of intravenous verapamil in cardiac arrhythmias. Br Med J. 1972 Mar 11;1(5801):660–662. [PMC free article] [PubMed]
  • Krikler DM, Spurrell RA. Verapamil in the treatment of paroxysmal supraventricular tachycardia. Postgrad Med J. 1974 Jul;50(585):447–453. [PMC free article] [PubMed]
  • Wellens HJ, Tan SL, Bär FW, Düren DR, Lie KI, Dohmen HM. Effect of verapamil studied by programmed electrical stimulation of the heart in patients with paroxysmal re-entrant supraventricular tachycardia. Br Heart J. 1977 Oct;39(10):1058–1066. [PMC free article] [PubMed]
  • Hagemeijer F. Verapamil in the management of supraventricular tachyarrhythmias occurring after a recent myocardial infarction. Circulation. 1978 Apr;57(4):751–755. [PubMed]
  • Sung RJ, Elser B, McAllister RG., Jr Intravenous verapamil for termination of re-entrant supraventricular tachycardias: intracardiac studies correlated with plasma verapamil concentrations. Ann Intern Med. 1980 Nov;93(5):682–689. [PubMed]
  • Waxman HL, Myerburg RJ, Appel R, Sung RJ. Verapamil for control of ventricular rate in paroxysmal supraventricular tachycardia and atrial fibrillation or flutter: a double-blind randomized cross-over study. Ann Intern Med. 1981 Jan;94(1):1–6. [PubMed]
  • Wellens HJ, Bär FW, Lie KI, Düren DR, Dohmen HJ. Effect of procainamide, propranolol and verapamil on mechanism of tachycardia in patients with chronic recurrent ventricular tachycardia. Am J Cardiol. 1977 Oct;40(4):579–585. [PubMed]
  • Bender F, Reploh HD. Behandlung von Kammertachykardien mit Isoptin. Med Klin. 1968 May 3;63(18):715–717. [PubMed]
  • Gotsman MS, Lewis BS, Bakst A, Mitha AS. Verapamil in life-threatening tachyarrhythmias. S Afr Med J. 1972 Dec 23;46(51):2017–2019. [PubMed]
  • Fauchier JP, Lanfranchi J, Ginies G, Raynaud R. Syncope par "torsade de pointe" au cours d'un traitement par la chloroquine Etude de l'électrogramme hisien et traitement par le vérapamil. Ann Cardiol Angeiol (Paris) 1974 Jul-Sep;23(4):341–346. [PubMed]
  • Wu D, Kou HC, Hung JS. Exercise-triggered paroxysmal ventricular tachycardia. A repetitive rhythmic activity possibly related to afterdepolarization. Ann Intern Med. 1981 Oct;95(4):410–414. [PubMed]
  • Hoffman BF, Rosen MR. Cellular mechanisms for cardiac arrhythmias. Circ Res. 1981 Jul;49(1):1–15. [PubMed]
  • Rosen MR, Reder RF. Does triggered activity have a role in the genesis of cardiac arrhythmias? Ann Intern Med. 1981 Jun;94(6):794–801. [PubMed]
  • Scherlag BJ, Lau SH, Helfant RH, Berkowitz WD, Stein E, Damato AN. Catheter technique for recording His bundle activity in man. Circulation. 1969 Jan;39(1):13–18. [PubMed]
  • Reddy CP, Gettes LS. Use of isoproterenol as an aid to electric induction of chronic recurrent ventricular tachycardia. Am J Cardiol. 1979 Oct;44(4):705–713. [PubMed]
  • McAllister RG, Howell SM. Fluorometric assay of verapamil in biological fluids and tissues. J Pharm Sci. 1976 Mar;65(3):431–432. [PubMed]
  • Wellens HJ. Value and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias. Circulation. 1978 May;57(5):845–853. [PubMed]
  • Rosen MR, Gelband H, Hoffman BF. Correlation between effects of ouabain on the canine electrocardiogram and transmembrane potentials of isolated Purkinje fibers. Circulation. 1973 Jan;47(1):65–72. [PubMed]
  • Ferrier GR, Saunders JH, Mendez C. A cellular mechanism for the generation of ventricular arrhythmias by acetylstrophanthidin. Circ Res. 1973 May;32(5):600–609. [PubMed]
  • Hashimoto K, Moe GK. Transient depolarizations induced by acetylstrophanthidin in specialized tissue of dog atrium and ventricle. Circ Res. 1973 May;32(5):618–624. [PubMed]
  • Ferrier GR. The effects of tension on acetylstrophanthidin-induced transient depolarizations and aftercontractions in canine myocardial and Purkinje tissues. Circ Res. 1976 Mar;38(3):156–162. [PubMed]
  • Wit AL, Cranefield PF. Triggered activity in cardiac muscle fibers of the simian mitral valve. Circ Res. 1976 Feb;38(2):85–98. [PubMed]
  • Wit AL, Cranefield PF. Triggered and automatic activity in the canine coronary sinus. Circ Res. 1977 Oct;41(4):434–445. [PubMed]
  • Hordof AJ, Spotnitz A, Mary-Rabine L, Edie RN, Rosen MR. The cellular electrophysiologic effects of digitalis on human atrial fibers. Circulation. 1978 Feb;57(2):223–229. [PubMed]
  • Wit AL, Fenoglio JJ, Jr, Hordof AJ, Reemtsma K. Ultrastructure and transmembrane potentials of cardiac muscle in the human anterior mitral valve leaflet. Circulation. 1979 Jun;59(6):1284–1292. [PubMed]
  • Mary-Rabine L, Hordof AJ, Danilo P, Jr, Malm JR, Rosen MR. Mechanisms for impulse initiation in isolated human atrial fibers. Circ Res. 1980 Aug;47(2):267–277. [PubMed]
  • Aronson RS, Gelles JM. The effect of ouabain, dinitrophenol, and lithium on the pacemaker current in sheep cardiac Purkinje fibers. Circ Res. 1977 May;40(5):517–524. [PubMed]
  • Tsien RW, Carpenter DO. Ionic mechanisms of pacemaker activity in cardiac Purkinje fibers. Fed Proc. 1978 Jun;37(8):2127–2131. [PubMed]
  • Kass RS, Tsien RW, Weingart R. Ionic basis of transient inward current induced by strophanthidin in cardiac Purkinje fibres. J Physiol. 1978 Aug;281:209–226. [PubMed]
  • Tritthart H, Fleckenstein B, Fleckenstein A. Some fundamental actions of antiarrhythmic drugs on the excitability and the contractility of singel myocardial fibers. Naunyn Schmiedebergs Arch Pharmakol. 1971;269(2):212–219. [PubMed]
  • Cranefield PF, Aronson RS, Wit AL. Effect of verapamil on the noraml action potential and on a calcium-dependent slow response of canine cardiac Purkinje fibers. Circ Res. 1974 Feb;34(2):204–213. [PubMed]
  • Zipes DP, Fischer JC. Effects of agents which inhibit the slow channel on sinus node automaticity and atrioventricular conduction in the dog. Circ Res. 1974 Feb;34(2):184–192. [PubMed]
  • Wellens HJ, Bär FW, Farré J, Ross DL, Wiener I, Vanagt EJ. Initiation and termination of ventricular tachycardia by supraventricular stimuli. Incidence and electrophysiologic determinants as observed during programmed stimulation of the heart. Am J Cardiol. 1980 Oct;46(4):576–582. [PubMed]
  • Zipes DP, Foster PR, Troup PJ, Pedersen DH. Atrial induction of ventricular tachycardia: reentry versus triggered automaticity. Am J Cardiol. 1979 Jul;44(1):1–8. [PubMed]
  • Wit AL, Cranefield PF, Gadsby DC. Electrogenic sodium extrusion can stop triggered activity in the canine coronary sinus. Circ Res. 1981 Oct;49(4):1029–1042. [PubMed]
  • Zipes DP, Besch HR, Jr, Watanabe AM. Role of the slow current in cardiac electrophysiology. Circulation. 1975 May;51(5):761–766. [PubMed]
  • Rosen MR, Wit AL, Hoffman BF. Electrophysiology and pharmacology of cardiac arrhythmias. VI. Cardiac effects of verapamil. Am Heart J. 1975 May;89(5):665–673. [PubMed]
  • Cranefield PF, Wit AL, Hoffman BF. Conduction of the cardiac impulse. 3. Characteristics of very slow conduction. J Gen Physiol. 1972 Feb;59(2):227–246. [PMC free article] [PubMed]
  • El-Sherif N, Lazzara R. Reentrant ventricular arrhythmias in the late myocardial infarction period. 7. Effect of verapamil and D-600 and the role of the "slow channel". Circulation. 1979 Sep;60(3):605–615. [PubMed]
  • Davis J, Glassman R, Wit AL. Method for evaluating the effects of antiarrhythmic drugs on ventricular tachycardias with different electrophysiologic characteristics and different mechanisms in the infarcted canine heart. Am J Cardiol. 1982 Apr 1;49(5):1176–1184. [PubMed]
  • Spear JF, Horowitz LN, Hodess AB, MacVaugh H, 3rd, Moore EN. Cellular electrophysiology of human myocardial infarction. 1. Abnormalities of cellular activation. Circulation. 1979 Feb;59(2):247–256. [PubMed]
  • Gilmour RF, Jr, Heger JJ, Prystowsky EN, Zipes DP. Cellular electrophysiologic abnormalities of diseased human ventricular myocardium. Am J Cardiol. 1983 Jan 1;51(1):137–144. [PubMed]

Articles from The Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation