Document Detail

Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia.
MedLine Citation:
PMID:  11216977     Owner:  NLM     Status:  MEDLINE    
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.
P Alboni; C Tomasi; C Menozzi; N Bottoni; N Paparella; G Fucà; M Brignole; R Cappato
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
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:
Created Date:  2001-02-16     Completed Date:  2001-03-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  548-53     Citation Subset:  AIM; IM    
Division of Cardiology, Ospedale Civile, Cento Fe, Italy.
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MeSH Terms
Administration, Oral
Ambulatory Care
Anti-Arrhythmia Agents / administration & dosage*,  adverse effects
Diltiazem / administration & dosage*,  adverse effects
Drug Therapy, Combination
Electrocardiography / drug effects*
Flecainide / administration & dosage*,  adverse effects
Middle Aged
Patient Readmission
Propranolol / administration & dosage*,  adverse effects
Self Administration
Self Care*
Tachycardia, Paroxysmal / drug therapy*
Tachycardia, Supraventricular / drug therapy*
Treatment Outcome
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 42399-41-7/Diltiazem; 525-66-6/Propranolol; 54143-55-4/Flecainide

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