Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Treatment of Atrial Arrhythmias: Effectiveness of Verapamil When Preceded by Calcium Infusion

Treatment of Atrial Arrhythmias: Effectiveness of Verapamil When Preceded by Calcium Infusion Abstract • Intravenous verapamil hydrochloride was used alone in 63 episodes of atrial fibrillation and flutter and six episodes of supraventricular tachycardia (SVT) (group A). Calcium chloride was given intravenously prior to verapamil in 41 episodes of fibrillation and flutter and 18 episodes of SVT (group B). All patients with SVT converted to normal sinus rhythm, with eight in group B converting after administration of calcium alone. Therapy lowered the heart rate in all patients with fibrillation and flutter; however, those given verapamil alone had a mean decrease in systolic pressure of 18.8 mm Hg; there was no change in those pretreated with calcium. The mean dose of verapamil required by group B was significantly lower than in group A. Many with atrial fibrillation or flutter who received digoxin subsequently converted to sinus rhythm. Thus, pretreatment with calcium decreased the hypotensive effect of verapamil without compromising its antiarrhythmic effect. (Arch Intern References 1. Singh B, Ellrodt G, Peter CT: Verapamil: A review of its pharmacological properties and therapeutic use. Drugs 1978;15:169-197.Crossref 2. Stone PH, Antman EM, Muller JE, et al: Calcium channel blocking agents in the treatment of cardiovascular disorders: II. Hemodynamic effects and clinical applications. Ann Intern Med 1980;93:886-904.Crossref 3. Talano JV, Feerst D: Verapamil: A new class of antiarrhythmic agent with a variety of beneficial cardiovascular effects. Arch Intern Med 1980;140:314-315.Crossref 4. Singh BN, Nademanee K, Baky SH: Calcium antagonists: Clinical use in the treatment of arrhythmias. Drugs 1983;25:125-153.Crossref 5. Karlsberg RP, Aronow WS: Calcium channel blockers: Indications and limitations: I. Clinical pharmacology and use as antiarrhythmic agents. Postgrad Med J 1982;72:97-110. 6. Opie LH: Calcium antagonists. Lancet 1980;1:806-810.Crossref 7. Ellrodt G, Chew CYC, Singh BN: Therapeutic implications of slow channel blockade in cardiocirculatory disorders. Circulation 1980;62: 669-679.Crossref 8. Rinkenberger RL, Prystowsky EN, Heger JJ, et al: Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias. Circulation 1980;62:996-1010.Crossref 9. 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;93:682-689.Crossref 10. Levine JH, Michael JR, Guarnier T: Treatment of multifocal atrial tachycardia with verapamil. N Engl J Med 1985;312:21-25.Crossref 11. Belhassen B, Rotmensch HH, Laniado S: Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1981;46:679-682.Crossref 12. Schamroth L, Krikler DM, Garrett C: Immediate effects of intravenous verapamil in cardiac arrhythmias. Br Med J 1972;1:660-662.Crossref 13. Heng MK, Singh BN, Roche AHG, et al: Effects of intravenous verapamil on cardiac arrhythmias on the electrocardiogram. Am Heart J 1975;90:487-498.Crossref 14. Hasin Y, Kriwisky M, Gotsman MS: Verapamil in ventricular tachycardia. Cardiology 1984;71:199-206.Crossref 15. Angus JA, Richmond DR, Dhumma-Upakorn P, et al: Cardiovascular action of verapamil in the dog with particular reference to myocardial contractility and atrioventricular conduction. Cardiovasc Res 1976;10: 623-632.Crossref 16. Singh BN, Hecht HS, Nademanee K, et al: Electrophysiologic and hemodynamic effects of slow-channel blocking drugs. Prog Cardiovasc Dis 1982;25:103-132.Crossref 17. Mangiardi LM, Hariman RJ, McAllister RG Jr, et al: Electrophysiologic and hemodynamic effects of verapamil: Correlation with plasma drug concentrations. Circulation 1978;57:366-372.Crossref 18. Singh BN, Roche AGH: Effects of intravenous verapamil on hemodynamics in patients with heart disease. Am Heart J 1977;94:593-599.Crossref 19. Lewis BS, Mitha AS, Gotsman MS: Immediate hemodynamic effects of verapamil in man. Cardiology 1975;60:366-376.Crossref 20. Husaini MH, Kvasnicka J, Ryden L, et al: Action of verapamil on sinus node, atrioventricular and intraventricular conduction. Br Heart J 1973;35:734-737.Crossref 21. Roy PR, Spurrell RAJ, Sowton E: The effect of verapamil on the cardiac conduction system in man. Postgrad Med J 1974;50:270-275.Crossref 22. Cranefield PF: Conduction of the Cardiac Impulse . London, Macdonald & Co Publishers Ltd, 1975. 23. Coraboeuf E: Ionic basis of electrical activity in cardiac tissue. Am J Physiol 1976;234:101-116. 24. Sacks H, Kennelly BM: Verapamil in cardiac arrhythmias. Br Med J 1972;2:716.Crossref 25. Hariman RJ, Mangiardi LM, McAllister RG, et al: Reversal of the cardiovascular effects of verapamil by calcium and sodium: Differences between electrophysiologic and hemodynamic responses. Circulation 1979;59:797-804.Crossref 26. Vick JA, Kandil A, Herman EH, et al: Reversal of propranolol and verapamil toxicity by calcium. Vet Hum Toxicol 1983;25:8-10. 27. Lipman J, Jardine I, Roos C, et al: Intravenous calcium chloride as an antidote to verapamil-induced hypotension. Intensive Care Med 1982;8: 55-57.Crossref 28. Hattori VT, Mandel WJ, Peter T: Calcium for myocardial depression from verapamil. N Engl J Med 1982;306:238. 29. Morris DL, Goldschlager N: Calcium infusion for reversal of adverse effects of intravenous verapamil. JAMA 1983;249:3212-3213.Crossref 30. Zoghbi W, Schwartz J: Verapamil overdose: Report of a case and review of literature. Cardiovasc Rev Rep 1984;5:356-359. 31. Moroni F, Manaioni PF: Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning. Clin Toxicol 1980;17: 395-400.Crossref 32. Perkins CM: Serious verapamil poisoning: Treatment with intravenous calcium gluconate. Br Med J 1978;2:1127.Crossref 33. Woie L, Storstein L: Successful treatment of suicidal verapamil poisoning with calcium gluconate. Eur Heart J 1981;2:239-242. 34. White RD, Goldsmith RS, Rodriguez R, et al: Plasma tonic calcium levels following injection of chloride, gluconate and gluceptate salts of calcium. J Thorac Cardiovasc Surg 1976;71:609-631. 35. Pak CYC, Zisman E, Lotz M, et al: Gluconate carrier in Ca kinetic studies. J Clin Endocrinol Metabol 1967;27:431-432.Crossref 36. Crump BJ, Holt DW, Vale JA: Lack of response to intravenous calcium in severe verapamil poisoning. Lancet 1982;2:939-940.Crossref 37. Jain SC, Bharadwaj RPS, Shukla RK, et al: Severe hypotension and bradycardia after suicidal consumption of 100 tablets of verapamil: A case report. Indian Heart J 1982;34:175-176. 38. Chimienti M, Previtali M, Medici A, et al: Acute verapamil poisoning: Successful treatment with epinephrine. Clin Cardiol 1982;5:219-222. 39. Immonen P, Linkola A, Waris E: Three cases of severe verapamil poisoning. Int J Cardiol 1981;1:101-105.Crossref 40. Orr GM, Bodansky JH, Dymond DS, et al: Fatal verapamil overdose. Lancet 1982;2:1218-1219.Crossref 41. Weiss AT, Lewis BS, Halon DA, et al: The use of calcium with verapamil in the management of supraventricular tachyarrhythmias. Int J Cardiol 1983;4:275-280.Crossref 42. Singh BN, Collett JT, Chew CYC: New perspectives in the pharmacologic therapy of cardiac arrhythmias. Prog Cardiovasc Dis 1980;22: 243-301.Crossref 43. Kleeman K, Singh BN: Serum electrolytes and the heart , in Maxwell MH, Kleeman CR (eds): Clinical Disorders of Fluid and Electrolyte Metabolism , ed 34. New York, McGraw-Hill International Book Co, 1980, pp 145-180. 44. Haft JI, Shahabadi A, Fano A: Clinical experience with ouabain administration in small divided doses in the monitored patient. Chest 1973;63:868-874.Crossref 45. Venkatachalapathy D, Gupta PK, Haft JI: Efficacy of drug therapy in the conversion of atrial fibrillation and flutter to normal sinus rhythm, abstracted. Clin Res 1972;20:402. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Treatment of Atrial Arrhythmias: Effectiveness of Verapamil When Preceded by Calcium Infusion

Download PDF
5 pages

Loading next page...
 
/lp/american-medical-association/treatment-of-atrial-arrhythmias-effectiveness-of-verapamil-when-5qRZpM4Xaw

References (46)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360180067011
Publisher site
See Article on Publisher Site

Abstract

Abstract • Intravenous verapamil hydrochloride was used alone in 63 episodes of atrial fibrillation and flutter and six episodes of supraventricular tachycardia (SVT) (group A). Calcium chloride was given intravenously prior to verapamil in 41 episodes of fibrillation and flutter and 18 episodes of SVT (group B). All patients with SVT converted to normal sinus rhythm, with eight in group B converting after administration of calcium alone. Therapy lowered the heart rate in all patients with fibrillation and flutter; however, those given verapamil alone had a mean decrease in systolic pressure of 18.8 mm Hg; there was no change in those pretreated with calcium. The mean dose of verapamil required by group B was significantly lower than in group A. Many with atrial fibrillation or flutter who received digoxin subsequently converted to sinus rhythm. Thus, pretreatment with calcium decreased the hypotensive effect of verapamil without compromising its antiarrhythmic effect. (Arch Intern References 1. Singh B, Ellrodt G, Peter CT: Verapamil: A review of its pharmacological properties and therapeutic use. Drugs 1978;15:169-197.Crossref 2. Stone PH, Antman EM, Muller JE, et al: Calcium channel blocking agents in the treatment of cardiovascular disorders: II. Hemodynamic effects and clinical applications. Ann Intern Med 1980;93:886-904.Crossref 3. Talano JV, Feerst D: Verapamil: A new class of antiarrhythmic agent with a variety of beneficial cardiovascular effects. Arch Intern Med 1980;140:314-315.Crossref 4. Singh BN, Nademanee K, Baky SH: Calcium antagonists: Clinical use in the treatment of arrhythmias. Drugs 1983;25:125-153.Crossref 5. Karlsberg RP, Aronow WS: Calcium channel blockers: Indications and limitations: I. Clinical pharmacology and use as antiarrhythmic agents. Postgrad Med J 1982;72:97-110. 6. Opie LH: Calcium antagonists. Lancet 1980;1:806-810.Crossref 7. Ellrodt G, Chew CYC, Singh BN: Therapeutic implications of slow channel blockade in cardiocirculatory disorders. Circulation 1980;62: 669-679.Crossref 8. Rinkenberger RL, Prystowsky EN, Heger JJ, et al: Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias. Circulation 1980;62:996-1010.Crossref 9. 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;93:682-689.Crossref 10. Levine JH, Michael JR, Guarnier T: Treatment of multifocal atrial tachycardia with verapamil. N Engl J Med 1985;312:21-25.Crossref 11. Belhassen B, Rotmensch HH, Laniado S: Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1981;46:679-682.Crossref 12. Schamroth L, Krikler DM, Garrett C: Immediate effects of intravenous verapamil in cardiac arrhythmias. Br Med J 1972;1:660-662.Crossref 13. Heng MK, Singh BN, Roche AHG, et al: Effects of intravenous verapamil on cardiac arrhythmias on the electrocardiogram. Am Heart J 1975;90:487-498.Crossref 14. Hasin Y, Kriwisky M, Gotsman MS: Verapamil in ventricular tachycardia. Cardiology 1984;71:199-206.Crossref 15. Angus JA, Richmond DR, Dhumma-Upakorn P, et al: Cardiovascular action of verapamil in the dog with particular reference to myocardial contractility and atrioventricular conduction. Cardiovasc Res 1976;10: 623-632.Crossref 16. Singh BN, Hecht HS, Nademanee K, et al: Electrophysiologic and hemodynamic effects of slow-channel blocking drugs. Prog Cardiovasc Dis 1982;25:103-132.Crossref 17. Mangiardi LM, Hariman RJ, McAllister RG Jr, et al: Electrophysiologic and hemodynamic effects of verapamil: Correlation with plasma drug concentrations. Circulation 1978;57:366-372.Crossref 18. Singh BN, Roche AGH: Effects of intravenous verapamil on hemodynamics in patients with heart disease. Am Heart J 1977;94:593-599.Crossref 19. Lewis BS, Mitha AS, Gotsman MS: Immediate hemodynamic effects of verapamil in man. Cardiology 1975;60:366-376.Crossref 20. Husaini MH, Kvasnicka J, Ryden L, et al: Action of verapamil on sinus node, atrioventricular and intraventricular conduction. Br Heart J 1973;35:734-737.Crossref 21. Roy PR, Spurrell RAJ, Sowton E: The effect of verapamil on the cardiac conduction system in man. Postgrad Med J 1974;50:270-275.Crossref 22. Cranefield PF: Conduction of the Cardiac Impulse . London, Macdonald & Co Publishers Ltd, 1975. 23. Coraboeuf E: Ionic basis of electrical activity in cardiac tissue. Am J Physiol 1976;234:101-116. 24. Sacks H, Kennelly BM: Verapamil in cardiac arrhythmias. Br Med J 1972;2:716.Crossref 25. Hariman RJ, Mangiardi LM, McAllister RG, et al: Reversal of the cardiovascular effects of verapamil by calcium and sodium: Differences between electrophysiologic and hemodynamic responses. Circulation 1979;59:797-804.Crossref 26. Vick JA, Kandil A, Herman EH, et al: Reversal of propranolol and verapamil toxicity by calcium. Vet Hum Toxicol 1983;25:8-10. 27. Lipman J, Jardine I, Roos C, et al: Intravenous calcium chloride as an antidote to verapamil-induced hypotension. Intensive Care Med 1982;8: 55-57.Crossref 28. Hattori VT, Mandel WJ, Peter T: Calcium for myocardial depression from verapamil. N Engl J Med 1982;306:238. 29. Morris DL, Goldschlager N: Calcium infusion for reversal of adverse effects of intravenous verapamil. JAMA 1983;249:3212-3213.Crossref 30. Zoghbi W, Schwartz J: Verapamil overdose: Report of a case and review of literature. Cardiovasc Rev Rep 1984;5:356-359. 31. Moroni F, Manaioni PF: Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning. Clin Toxicol 1980;17: 395-400.Crossref 32. Perkins CM: Serious verapamil poisoning: Treatment with intravenous calcium gluconate. Br Med J 1978;2:1127.Crossref 33. Woie L, Storstein L: Successful treatment of suicidal verapamil poisoning with calcium gluconate. Eur Heart J 1981;2:239-242. 34. White RD, Goldsmith RS, Rodriguez R, et al: Plasma tonic calcium levels following injection of chloride, gluconate and gluceptate salts of calcium. J Thorac Cardiovasc Surg 1976;71:609-631. 35. Pak CYC, Zisman E, Lotz M, et al: Gluconate carrier in Ca kinetic studies. J Clin Endocrinol Metabol 1967;27:431-432.Crossref 36. Crump BJ, Holt DW, Vale JA: Lack of response to intravenous calcium in severe verapamil poisoning. Lancet 1982;2:939-940.Crossref 37. Jain SC, Bharadwaj RPS, Shukla RK, et al: Severe hypotension and bradycardia after suicidal consumption of 100 tablets of verapamil: A case report. Indian Heart J 1982;34:175-176. 38. Chimienti M, Previtali M, Medici A, et al: Acute verapamil poisoning: Successful treatment with epinephrine. Clin Cardiol 1982;5:219-222. 39. Immonen P, Linkola A, Waris E: Three cases of severe verapamil poisoning. Int J Cardiol 1981;1:101-105.Crossref 40. Orr GM, Bodansky JH, Dymond DS, et al: Fatal verapamil overdose. Lancet 1982;2:1218-1219.Crossref 41. Weiss AT, Lewis BS, Halon DA, et al: The use of calcium with verapamil in the management of supraventricular tachyarrhythmias. Int J Cardiol 1983;4:275-280.Crossref 42. Singh BN, Collett JT, Chew CYC: New perspectives in the pharmacologic therapy of cardiac arrhythmias. Prog Cardiovasc Dis 1980;22: 243-301.Crossref 43. Kleeman K, Singh BN: Serum electrolytes and the heart , in Maxwell MH, Kleeman CR (eds): Clinical Disorders of Fluid and Electrolyte Metabolism , ed 34. New York, McGraw-Hill International Book Co, 1980, pp 145-180. 44. Haft JI, Shahabadi A, Fano A: Clinical experience with ouabain administration in small divided doses in the monitored patient. Chest 1973;63:868-874.Crossref 45. Venkatachalapathy D, Gupta PK, Haft JI: Efficacy of drug therapy in the conversion of atrial fibrillation and flutter to normal sinus rhythm, abstracted. Clin Res 1972;20:402.

Journal

Archives of Internal Medicine – American Medical Association

Published: Jun 1, 1986

There are no references for this article.