Author + information
- Received July 5, 1988
- Revision received September 29, 1988
- Accepted October 19, 1988
- Published online March 1, 1989.
- Edward C Huycke, MD, FACC∗,
- Ruey J Sung, MD, FACC∗,†,
- Virgil C Dias, PHARM D‡,
- Simon Milstein, MD§,
- Robert J Hariman, MD, FACC¶,
- Edward V Platia, MD, FACC¶,
- The multicenter diltiazem psvt study group∗∗
- ↵∗Address for reprints:Ruey J. Sung, MD, 5G1, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, California 94110.
To assess the efficacy and safety of intravenous diltiazem, 54 patients with inducible sustained supraventricular tachycardia received diltiazem, 0.25 mg/kg or 0.25 mg/kg, followed by 0.35 mg/kg body weight, or placebo in a double-blind, randomized study. Twenty patients had atrioventricular (AV) node reentrant tachycardia, whereas 34 had orthodromic AV reciprocating tachycardia associated with the Wolfl-Parkinson-White syndrome. Supraventricular tachycardia was terminated in 24 (86%) of 28 patients given intravenous diltiazem compared with 5 (19%) of 26 given placebo (p = 0.0000014). Nineteen (95%) of 20 patients initially given placebo had termination of supraventricular tachycardia after receiving diltiazem. Overall, 43 (90%) of 48 patients receiving intravenous diltiazem had conversion of supraventricular tachycardia to sinus rhythm; the median time to tachycardia termination was 2 min after initiation of a 2 min diltiazem infusion.
All 20 patients (100%) with AV node reentrant tachycardia treated with diltiazem had conversion of tachycardia to sinus rhythm as did 26 (81%) of 30 patients with AV reciprocating tachycardia treated with diltiazem. Diltiazem prolonged refractoriness and slowed conduction of the AV node and thereby provided antiarrhythmic action to cause tachycardia termination. Diltiazem had no effect on the electrophysiologic properties of accessory AV connections. Adverse effects were seen in 3 (6%) of the 48 patients given diltiazem.
For paroxysmal supraventricular tachycardia initiated in the electrophysiology laboratory, it is concluded that intravenous diltiazem is safe and very effective for acute tachycardia termination when the AV node is part of the reentrant circuit.
↵∗∗ The collaborating centers and coinvestigators of the Multicenter Diltiazem PSVT Study Group are listed in the Appendix. The opinions expressed herein are those of the authors and do not represent policy of the Department of the Army or the Department of Defense. This study was presented in part at the 37th Annual Meeting of the American College of Cardiology, Atlanta, Georgia, March 1988.
☆ This work was supported in part by a grant from Marion Laboratories, Inc.
☆☆ We thank Leon Lord for invaluable secretarial assistance.
- Received July 5, 1988.
- Revision received September 29, 1988.
- Accepted October 19, 1988.