| Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia. | |
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MedLine Citation:
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PMID: 11216977 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We tested the efficacy of two drug treatments, flecainide (F) and the combination ofdiltiazem and propranolol (D/P), administered as a single oral dose for termination of the arrhythmic episodes. BACKGROUND: Both prophylactic drug therapy and catheter ablation are questionable as first-line treatments in patients with infrequent and well-tolerated episodes of paroxysmal supraventricular tachycardia (SVT). METHODS: Among 42 eligible patients (13% of all screened for SVT) with infrequent (< or =5/year), well-tolerated and long-lasting episodes, 37 were enrolled and 33 had SVT inducible during electrophysiological study. In the latter, three treatments (placebo, F, and D/P) were administered in a random order 5 min after SVT induction on three different days. RESULTS: Conversion to sinus rhythm occurred within 2 h in 52%, 61%, and 94% of patients on placebo, F and D/P, respectively (p < 0.001). The conversion time was shorter after D/P (32 +/- 22 min) than after placebo (77 +/- 42 min, p < 0.001) or F (74 +/- 37 min, p < 0.001). Four patients (1 placebo, 1 D/P, and 2 F) had hypotension and four (3 D/P and 1 F) a sinus rate <50 beats/min following SVT interruption. Patients were discharged on a single oral dose of the most effective drug treatment (F or D/P) at time of acute testing. Twenty-six patients were discharged on D/P and five on F. During 17 +/- 12 months follow-up, the treatment was successful in 81% of D/P patients and in 80% of F patients, as all the arrhythmic episodes were interrupted out-of-hospital within 2 h. In the remaining patients, a failure occurred during one or more episodes because of drug ineffectiveness or drug unavailability. One patient had syncope after D/P ingestion. During follow-up, the percentage of patients calling for emergency room assistance was significantly reduced as compared to the year before enrollment (9% vs. 100%, p < 0.0001). CONCLUSIONS: The episodic treatment with oral D/P and F, as assessed during acute testing, appears effective in the management of selected patients with SVT. This therapeutic strategy minimizes the need for emergency room admissions during tachycardia recurrences. |
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Authors:
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P Alboni; C Tomasi; C Menozzi; N Bottoni; N Paparella; G Fucà; M Brignole; R Cappato |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 37 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2001 Feb |
Date Detail:
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Created Date: 2001-02-16 Completed Date: 2001-03-01 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 548-53 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Ospedale Civile, Cento Fe, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Adolescent Adult Aged Ambulatory Care Anti-Arrhythmia Agents / administration & dosage*, adverse effects Diltiazem / administration & dosage*, adverse effects Drug Therapy, Combination Electrocardiography / drug effects* Female Flecainide / administration & dosage*, adverse effects Humans Male Middle Aged Patient Readmission Propranolol / administration & dosage*, adverse effects Self Administration Self Care* Tachycardia, Paroxysmal / drug therapy* Tachycardia, Supraventricular / drug therapy* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents; 42399-41-7/Diltiazem; 525-66-6/Propranolol; 54143-55-4/Flecainide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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