Document Detail

Pharmacological stress testing of the His-Purkinje system in patients with bifascicular block.
MedLine Citation:
PMID:  9793094     Owner:  NLM     Status:  MEDLINE    
This literature review, based mainly on the English-language literature, focuses on pharmacological stress testing of the His-Purkinje system as part of an invasive electrophysiological study. The main target group for this investigation is patients with bifascicular block and syncope in which intermittent high grade AV block is suspected. Several drugs have been used for this purpose, mainly Class I antiarrhythmic agents such as ajmaline, procainamide, disopyramide, and flecainide. Most studies, unfortunately, suffer from limited patient numbers, lack of adequate control groups, and/or adequate follow-up. The sensitivity of the disopyramide stress test has been shown to be 75%-100% for prediction of impending high grade AV block. The specificity was > 90%. Studies on procainamide have shown a sensitivity of 60% but the specificity has not been assessed. There are no studies allowing a strict comparison of the diagnostic value of pharmacological provocation with different drugs. Based on the similarities of the electrophysiological effects on the His-Purkinje system of the above Class I agents, it is reasonable to assume that all of them might be of diagnostic value in the present clinical context, provided atrial and ventricular stimulation after drug is included in the protocol.
A Englund; L Bergfeldt; M Rosenqvist
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  21     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1998-12-21     Completed Date:  1998-12-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1979-87     Citation Subset:  IM    
Department of Cardiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
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MeSH Terms
Anti-Arrhythmia Agents / diagnostic use*
Bundle of His / drug effects*,  physiopathology
Cardiac Pacing, Artificial
Heart Block / diagnosis*,  physiopathology
Purkinje Fibers / drug effects*,  physiopathology
Sensitivity and Specificity
Reg. No./Substance:
0/Anti-Arrhythmia Agents

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

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