Electropharmacological testing by transoesophageal atrial pacing in inducible supraventricular tachyarrhythmias. A good approach for selection of long-term anti-arrhythmic therapy.
Sixty-eight patients with disabling episodes of inducible supraventricular tachyarrhythmia were tested electropharmacologically by transoesophageal atrial pacing. Using this technique we induced clinical arrhythmia in 67 (98.5%); 26 (38.8%) had a reciprocating tachycardia due to AV node reentry and 41 (61.2%) a by-pass tract. In the latter we induced a reciprocating tachycardia in 12 (29.3%), atrial fibrillation in 25 (36.5%) and both in 14 (34.2%). We then performed an anti-arrhythmic drug test and a transoesophageal reevaluation either after acute intravenous drug administration or during oral steady state. Altogether we tested 111 drugs or a combination of drugs before the results were considered positive; all patients tolerated the procedure well and were discharged with the drug or combination of drugs judged effective. At follow-up of 16.6 +/- 8.5 months, 42 patients (62.7%) were symptom-free, 17 (25.3%) had minor and non-disabling relapses, six (9%) stopped the drug because of inefficacy (1-1.5%) or side effects (5-7.5%); two (3%) dropped out. We conclude that electropharmacological testing with transoesophageal pacing constitutes a very good approach for inducible supraventricular tachyarrhythmias: it permits selection of optimal long-term anti-arrhythmic treatment and is well tolerated, only slightly invasive and without adverse effects.
Guarnerio
M
M
Divisione di Cardiologia, Ospedale S. Chiara, Trento, Italy.
Furlanello
F
F
Vergara
G
G
Inama
G
G
Del Greco
M
M
Accardi
R
R
Dallago
M
M
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002304:Cardiac Pacing, Artificial; D004338:Drug Combinations; D004947:Esophagus; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000188:drug therapy* / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D004338:Drug Combinations