[Electrophysiologic effects of calcium channel blockers on supraventricular tachycardia in children].
Calcium channel blockers (diltiazem or verapamil) were administered in 17 pediatric patients with supraventricular tachycardia to evaluate their drug effects on electrophysiologic properties and the tachycardia zone. Using electrophysiologic technique, 10 patients were diagnosed as having orthodromic reciprocating tachycardia (ORT), including three patients with concealed atrioventricular bypass tracts. Four patients were diagnosed as having atrioventricular nodal re-entrant tachycardia (AVNRT) of the slow-fast type and three patients were diagnosed as having intra-atrial re-entrant tachycardia (IART). Diltiazem was given to 10 patients; verapamil, to eight patients at doses of 0.15-0.2 mg/kg intravenously. Electrophysiologic properties and the tachycardia zone were then evaluated before and after the administration of calcium channel blockers. Diltiazem and verapamil produced no significant changes in the sinus node and atrial functions including basic sinus cycle length, sinoatrial conduction time, maximum sinus node recovery time and the effective atrial refractory period. Although sinus cycle length was shortened after verapamil in half the cases, it was due to increased sympathetic tone secondary to hypotension rather than to direct action of verapamil. Calcium channel blockers, however, prolonged the PR interval and significantly increased the effective refractory period of the atrioventricular node. Properties of the atrioventricular bypass tracts were not affected by calcium channel blockers. Diltiazem and verapamil were markedly effective in ORT and AVNRT. Their re-entrant circuits, including the atrioventricular node and the tachycardia zones, were shortened or resolved. However, IART showed no significant change in the tachycardia zone after the administration of calcium channel blockers, because the re-entrant circuit was not present within the atrioventricular node.(ABSTRACT TRUNCATED AT 250 WORDS)
Fujino
H
H
Department of Pediatrics, Shiga University of Medical Science, Otsu.
Fujiseki
Y
Y
Shimada
M
M
D000293:Adolescent; D001283:Atrioventricular Node / Q000187:drug effects / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004110:Diltiazem / Q000627:therapeutic use; D004594:Electrophysiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012849:Sinoatrial Node / Q000187:drug effects / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000188:drug therapy* / Q000503:physiopathology; D014700:Verapamil / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D014700:Verapamil; D004110:Diltiazem