Termination of paroxysmal supraventricular tachycardia with a single oral dose of diltiazem and propranolol

S. J. Yeh, F. C. Lin, Y. Y. Chou, J. S. Hung, D. Wu

Research output: Contribution to journalJournal Article peer-review

46 Scopus citations

Abstract

The efficacy of a single oral dose combination of 120 mg diltiazem and 160 mg propranolol in terminating paroxysmal supraventricular tachycardia (PSVT) was evaluated in 15 patients. All 15 patients underwent electrical induction of PSVT that lasted longer than 15 min, and all underwent randomized crossover placebo and diltiazem and propranolol studies on 2 consecutive days. On each day PSVT was induced and placebo or diltiazem and propranolol was administered 15 min later. Electrical conversion of PSVT was performed when severe symptoms occurred or at the end of 240 min. With placebo PSVT lasted 164 ± 89 (mean ± SD) min; four patients had spontaneous conversion. With diltiazem and propranolol PSVT lasted 39 ± 49 min (p < .001); 14 patients had spontaneous conversion in an average of 27 ± 15 min. None of the 14 patients had electrical reinduction of sustained PSVT after conversion. The sinus nodal recovery time during spontaneous or electrical conversion of PSVT was 911 ± 459 msec with placebo and 1076 ± 270 msec with diltiazem and propranolol (NS). Two patients developed transient second-degree atrioventricular block and junctional rhythm while on diltiazem and propranolol. Serum diltiazem and propranolol levels (ng/ml) after diltiazem and propranolol in five patients were, respectively, 49 ± 26 and 108 ± 101 at 15 min, 232 ± 147 and 228 ± 148 at 30 min, 254 ± 169 and 370 ± 393 at 45 min, 280 ± 115 and 209 ± 189 at 60 min, 188 ± 72 and 268 ± 264 at 120 min, and 118 ± 57 and 265 ± 148 at 240 min. Follow-up study after 5.6 ± 0.9 months revealed 51 spontaneous episodes of PSVT in the patient group; 50 of the 51 episodes were converted after the single oral dose of the diltiazem and propranolol combination, with a conversion time of 21 ± 16 min. In conclusion, a single oral dose combination of diltiazem and propranolol effectively terminates acute episodes of PSVT and may be considered the therapeutic regimen of choice in selected patients.

Original languageEnglish
Pages (from-to)104-109
Number of pages6
JournalCirculation
Volume71
Issue number1
DOIs
StatePublished - 1985

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