| Effect of flecainide on atrial and ventricular refractoriness and conduction in patients with normal left ventricle. Implications for possible antiarrhythmic and proarrhythmic mechanisms. | |
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MedLine Citation:
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PMID: 8682029 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We studied the effects of intravenous flecainide (2 mg.kg-1) on atrial and ventricular refractoriness and conduction during sinus rhythm, induced atrial fibrillation and atrial pacing at rates of 100, 120 and 150 ppm, in 14 patients with normal left ventricle. Flecainide caused a significant increase in QRS duration during sinus rhythm (mean +/- SD: 87.2 +/- 8.4 ms vs 102.8 +/- 9.1 ms, P < 0.001), atrial fibrillation (87.8 +/- 10.0 ms vs 108.8 +/- 13.7 ms, P < 0.001) and at all paced rates. The duration of the atrial electrogram was significantly increased during sinus rhythm (54.9 +/- 13.2 ms vs 64.8 +/- 16.6 ms, P = 0.003) and at all pacing rates. The PA interval was also significantly prolonged, as was the pacing stimulus-to-atrial-electrogram interval at all pacing rates. There was increased QRS duration and atrial electrogram prolongation at higher pacing rates. Atrial refractoriness was prolonged during sinus rhythm (216.4 +/- 28.2 vs 228.6 +/- 36.1, P = 0.02), but not during atrial pacing at any rate. The QT interval, but not the JT interval or ventricular refractoriness, was significantly prolonged during sinus rhythm and at all pacing rates. Flecainide slows atrial conduction in a use dependent manner and increases atrial refractoriness during sinus rhythm but not during faster atrial pacing, thus not displaying a use-dependent effect. QRS duration is prolonged in a use-dependent manner without a commensurate increase in ventricular refractoriness. In the presence of rapidly conducted atrial fibrillation, which was not found to be slowed by flecainide, this effect may constitute a proarrhythmic mechanism even in patients with no apparent myocardial abnormality. |
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Authors:
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D Katritsis; E Rowland; S O'Nunain; C F Shakespeare; J Poloniecki; A J Camm |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: European heart journal Volume: 16 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 1995 Dec |
Date Detail:
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Created Date: 1996-08-16 Completed Date: 1996-08-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 1930-5 Citation Subset: IM |
Affiliation:
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Department of Cardiological Sciences, St George's Hospital Medical School, London, U.K. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-Arrhythmia Agents / adverse effects, therapeutic use* Atrial Fibrillation / chemically induced, drug therapy Atrial Flutter / chemically induced, drug therapy Cardiac Pacing, Artificial Dose-Response Relationship, Drug Electrocardiography / drug effects* Female Flecainide / adverse effects, therapeutic use* Heart Atria / drug effects*, physiopathology Heart Ventricles / drug effects*, physiopathology Humans Infusions, Intravenous Male Middle Aged Risk Factors Tachycardia, Supraventricular / chemically induced, drug therapy* |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents; 54143-55-4/Flecainide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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