[Successful treatment of stress-induced therapy refractory ventricular tachycardia with verapamil].
A 51-year-old woman was admitted to the hospital for further elucidation of a syncope of unknown origin and exercise-induced tachycardias with broad QRS-complex. The tachycardia was induced by bicycle exercise stress testing, had a frequency of 165/min, showed an inferior axis and left bundle branch block. Organic heart disease was excluded by right and left heart catheterization and selective coronary angiography. A nodoventricular bundle or an atrio-ventricular bundle was excluded by an extensive electrophysiologic study, therefore the documented tachycardia was probably of ventricular origin. However, it was not possible to induce a ventricular tachycardia by programmed ventricular stimulation with up to three extrastimuli even after the infusion of isoprenaline. Sotalol (2 x 160 mg/die) and the combined treatment with mexiletine (2 x 360 mg/die) and disopyramide (2 x 250 mg/die) did not prevent the induction of the tachycardia by exercise testing. The combination of sotalol and flecainide (2 x 100 mg/die) evoked complex ventricular arrhythmias at rest not noted before, and it was therefore withdrawn as well. After all antiarrhythmic drugs were withdrawn verapamil was given in a dose of 3 x 120 mg and this therapy reproduceably prevented the induction of ventricular tachycardia by exercise testing.
Kühlkamp
V
V
Abteilung Innere Medizin III, Eberhard-Karls-Universität Tübingen.
Kohler
S
S
Seipel
L
L
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D005117:Cardiac Complexes, Premature / Q000188:drug therapy; D002304:Cardiac Pacing, Artificial; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D013610:Tachycardia / Q000188:drug therapy*; D014700:Verapamil / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D014700:Verapamil
Erfolgreiche Behandlung einer belastungsinduzierten therapierefraktären ventrikulären Tachykardie mit Verapamil.