Document Detail


Clinical evaluation of the enhancement of vagal tone in acute myocardial infarction by edrophonium hydrochloride: effects on ventricular arrhythmias, His bundle electrography, and left ventricular function.
MedLine Citation:
PMID:  835466     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Enhanced electrical stability of acutely ischemic myocardium with vagal stimulation and acetylcholinesterase inhibition has been demonstrated experimentally. To extend these findings clinically, within 24 hours of acute myocardial infarction, 11 patients underwent continuous 10 hour Holter monitoring: 2.5 hour control before and after 5 hour constant edrophonium infusion (0.25 to 2.00 mg./minute). Continuous infusion of the agent lowered heart rate 92 to 78 b.p.m. (p less than 0.01). Although mean total ventricular extrasystoles (PVC's) per 5 hours per patient (131) and PVC's per 1,000 beats (4.7) were unchanged (p greater than 0.05), potentially lethal tachyarrhythmias (malignant PVC's: multifocal, R on T, paried, greater than 5 per minute or ventricular tachycardia) were terminated in six of 10 patients by edrophonium. However, serious ventricular arrhythmias continued in three patients and appeared in four despite the agent. Ventricular fibrillation did not occur during the 10 hour period of study. In addition, the patients were evaluated hemodynamically and by His bundle electrograms before and after a 10 mg. bolus of edrophonium prior to the 10 hour constant infusion: heart rate declined (88 to 72 b.p.m., p less than 0.01), while mean arterial pressure (98 mm. Hg), left ventricular filling pressure (14 mm. Hg), cardiac index (2.4 L. per minute per square meter), and stroke work index (36 Gm.m./M.2) were unchanged (p greater than 0.05). The edrophonium bolus prolonged the A-H interval (117 to 135 msec., p less than 0.01) while the H-Q interval was unaltered (48 msec; p greater than 0.05). It is concluded that increased vagal tone with edrophonium did not reduce the over-all presence of premature ventricular contractions in the entire study group; however, the malignant nature of PVCs and ventricular tachycardia appeared to be lessened by the parasympathomimetic agent in certain patients. In addition, no adverse hemodynamic or intraventricular conduction effects were produced by edrophonium administration.
Authors:
R R Miller; H G Olson; Z Vera; A N DeMaria; E A Amsterdam; D T Mason
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  93     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1977 Feb 
Date Detail:
Created Date:  1977-03-15     Completed Date:  1977-03-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  222-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acetylcholinesterase
Adult
Aged
Arrhythmias, Cardiac / prevention & control
Bundle of His / drug effects,  physiopathology*
Edrophonium / adverse effects,  analogs & derivatives*,  pharmacology,  therapeutic use
Electrocardiography
Female
Heart Conduction System / physiopathology*
Heart Ventricles / drug effects,  physiopathology
Hemodynamics / drug effects
Humans
Male
Middle Aged
Myocardial Infarction / physiopathology*
Stimulation, Chemical
Vagus Nerve / drug effects*
Chemical
Reg. No./Substance:
312-48-1/Edrophonium; EC 3.1.1.7/Acetylcholinesterase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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