Effect of selective intracoronary antiarrhythmic drug administration in sustained ventricular tachycardia.
The effect of selective intracoronary antiarrhythmic drug infusion on inducibility of cardiac arrhythmias was studied in 3 patients with recurrent sustained monomorphic ventricular tachycardia referred for comprehensive electrophysiologic studies. Each patient had evidence of prior myocardial infarction, 1 or more occluded coronary arteries and a readily identifiable collateral vessel that provided collateral flow to the infarct-related artery. In each patient, the clinical arrhythmia was reproducibly inducible by programmed stimulation in the control state. After positioning a small infusion catheter in the collateral vessel, selective intracoronary lidocaine 0.3 to 0.6 mg/min (patients 1 and 2) or procainamide 0.1 to 1.4 mg/min (patient 3) was infused for a 10-minute period. In each patient the clinical arrhythmia was rendered noninducible during selective intracoronary drug infusion. The arrhythmia was again inducible after a 10-minute drug-washout period and also after standard intravenous doses of antiarrhythmic drug. Selective intracoronary antiarrhythmic drug infusion may help to localize the site of origin of some cardiac arrhythmias, may provide a means of testing the effects of several drugs during a single study and may be a new method for studying mechanisms of action of antiarrhythmic drugs.
Clinical Electrophysiology Laboratory, Brigham and Women's Hospital, Boston, Massachusetts 02115.
P L
PL
Friedman
A P
AP
Selwyn
E
E
Edelman
P J
PJ
Wang
D000792:Angiography; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D003331:Coronary Vessels; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage; D011342:Procainamide / Q000627:therapeutic use; D013610:Tachycardia / Q000000981:diagnostic imaging / Q000503:physiopathology*
D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; D011342:Procainamide