Document Detail

The electrophysiologic effects of enoximone in patients with preexisting ventricular tachyarrhythmias.
MedLine Citation:
PMID:  2521415     Owner:  NLM     Status:  MEDLINE    
Electrophysiologic and hemodynamic effects of intravenous enoximone were studied in 15 male patients, mean age 62.2 years, with New York Heart Association classes II to IV congestive heart failure (coronary artery disease in 10 and idiopathic dilated cardiomyopathy in five patients; mean ejection fraction, 0.19). All patients had spontaneous ventricular tachyarrhythmias; eight had sustained ventricular tachycardia (VT), one had ventricular fibrillation, and six had nonsustained VT. Hemodynamic and electrophysiologic parameters including VT induction were determined before and during an intravenous infusion of enoximone. The cardiac index increased (2.49 +/- 0.89 to 2.96 +/- 0.78), and the pulmonary capillary wedge pressure decreased (22.4 +/- 13.2 to 10.0 +/- 9.0) after enoximone per predefined protocol endpoints. There was a significant decrease in spontaneous sinus cycle length, corrected sinus nodal recovery time, AH interval during atrial pacing, shortest cycle length at which 1:1 atrioventricular nodal conduction occurred, and refractory periods of the atrium, ventricle, and atrioventricular node. Enoximone did not alter the cycle length of induced VT, and there was no consistent change in the number of extrastimuli required for VT induction. A baseline 24-hour ECG recording was obtained on 14 patients (while receiving a long-term antiarrhythmic drug regimen, if needed) and repeated after 1 week and 1 month of oral enoximone therapy. There was no significant increase in the number of premature ventricular complexes per hour or VT episodes per 24 hours after 1 week or 1 month of therapy with enoximone. However, if four patients who received amiodarone and may not yet have reached steady state were excluded from analysis, there was a significant increase in the frequency of premature ventricular complexes per hour 1 month after initiation of enoximone. We conclude that intravenous enoximone reduces pulmonary capillary wedge pressure and increases cardiac output in most patients. Intravenous enoximone in doses sufficient to have hemodynamic effects shortens atrial, ventricular, and atrioventricular nodal refractoriness and decreases AV nodal conduction time but has no consistent effect on VT induction or VT cycle length. The frequency of spontaneous ventricular ectopy may increase in some patients after oral enoximone, but its clinical significance is undefined. Enoximone may be administered cautiously to patients with congestive heart failure and preexisting ventricular tachyarrhythmias.
W M Miles; J J Heger; J D Minardo; L S Klein; E N Prystowsky; D P Zipes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  117     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1989 Jan 
Date Detail:
Created Date:  1989-02-15     Completed Date:  1989-02-15     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:  112-21     Citation Subset:  AIM; IM    
Krannert Institute of Cardiology, Indianapolis, IN 46202.
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MeSH Terms
Administration, Oral
Amiodarone / therapeutic use
Arrhythmias, Cardiac / complications,  physiopathology*
Blood Pressure / drug effects
Cardiac Pacing, Artificial
Cardiotonic Agents / administration & dosage,  pharmacology*
Heart Conduction System / physiopathology
Heart Failure / complications,  drug therapy*
Imidazoles / administration & dosage,  pharmacology*
Infusions, Intravenous
Middle Aged
Pulmonary Wedge Pressure / drug effects
Stroke Volume / drug effects
Grant Support
Reg. No./Substance:
0/Cardiotonic Agents; 0/Imidazoles; 1951-25-3/Amiodarone; 77671-31-9/Enoximone
Comment In:
Am Heart J. 1990 Jun;119(6):1450   [PMID:  2141225 ]

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