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Electrophysiological study of reciprocating tachycardia utilizing retrograde accessory pathways especially about the effectiveness and mechanism of action of verapamil and disopyramide

, : Electrophysiological study of reciprocating tachycardia utilizing retrograde accessory pathways especially about the effectiveness and mechanism of action of verapamil and disopyramide. Medical Journal of Kobe University 45(1): 91-104

The effectiveness and mechanism of action were electrophysiologically studied after 10 mg of i.v. verapamil (V) and 100 mg of i.v. disopyramide (D) on reciprocating tachycardia (RT) utilizing retrograde accessory pathway (AP) in 27 patients including 23 cases of Wolff-Parkinson-White syndrome (WPW), 2 cases of concealed WPW and 1 case of concealed atrio-His bypass. Conduction properties were evaluated before and after each drug using incremental atrial pacing; atrial extrastimulus testing; incremental ventricular pacing and ventriclar extrastimulus testing. V revealed a remarkable effect in delaying conduction and prolonging refractoriness in the atrioventricular node (AVN), while D had a variable effect in the AVN. D produced complete antegrade block in the AP in 7 of 12 cases with WPW syndrome. Although antegrade effective refractory period of AP (APPAERP) was not significantly prolonged in the other 5 cases, AP conduction was suppressed after D by the incremental atrial pacing. V could terminate the induced RT in all 7 cases, but D could neither terminate the induced RT nor decrease the cardiac rate remarkably in all 4 cases including 1 case of WPW, 2 cases of concealed WPW and 1 case of concealed atrio-His bypass. V was effective in terminating sustained RT in the majority of patients with WPW syndrome because of an increase in AV nodal refractoriness, but D was not always effective in these cases.

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