RT-178
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Oral antiarrhythmic drugs
for the termination of paroxysmal supraventricular reentrant
tachycardia
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Paolo Alboni, Corrado Tomasi*, Carlo Menozzi*, Nicola Bottoni*, Nelly Paparella, Giuseppe Fuca, Riccardo Cappato**, Michele Brignole***.
Division of Cardiology, Ospedale Civile, Cento,
*Section of Arrhythmology, Department of Cardiology,
Ospedale S. Maria Nuova, Reggio Emilia, Italy,
**Medizinische Abteilung, AK St. George, Hamburg, Germany,
***Section of Arrhythmology, Department of Cardiology,
Ospedali Riuniti, Lavagna, Italy
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Abstract
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Both prophylactic drug therapy and catheter ablation are questionable
as first-line treatments in patients with infrequent and well-tolerated episodes of paroxysmal supraventricular
tachycardia (SVT). We tested the efficacy of two drug treatments, flecainide (F) and the combination of diltiazem
and propranolol (D/P), administered as a single oral dose for termination of the arrhythmic episodes.
Among 42 eligible patients (13% of all screened for SVT) with infrequent (£5/year), well-tolerated and long-lasting
episodes, 37 were enrolled and 33 had SVT inducible during electrophysiological study. In the latter, 3 treatments
(placebo, F and D/P) were administered in a random order 5 min after SVT induction on 3 different days.
Conversion to sinus rhythm occurred within 2 hours in 52, 61 and 94% of patients on placebo, F and D/P,
respectively (p<0.001). The conversion time was shorter after D/P (32±22 min) than after placebo (77±42 min,
p<0.001) or F (74±37 min, p<0.001). Four patients (1 placebo, 1 D/P and 2 F) had hypotension and 4 (3 D/P and 1 F)
a sinus rate<50 bpm following SVT interruption. Patients were discharged on a single oral dose of the most
effective drug treatment (F or D/P) at time of acute testing.
Twenty-six patients were discharged on D/P and 5 on F. During 17±12 months follow-up, 85 of 93 arrhythmic
episodes (91%) in patients assigned to D/P (conversion time, 41±24 min) and 21 of 25 arrhythmic episodes (84%) in
patients assigned to F (conversion time, 43±18 min) were interrupted out-of-hospital within 2 hours. One patient
had syncope after D/P ingestion. During follow-up, the percentage of arrhythmic episodes requiring emergency
room admission in both groups was at 5% (D/P) and 0% (F), significantly reduced as compared to that observed in
the year before enrollment (D/P, 47%, p<0.05; F, 57%, p<0.05).
The episodic treatment with oral D/P and F, as assessed during acute testing, is safe and effective in the
management of selected patients with SVT. This therapeutic strategy minimizes the need for emergency room
admissions during tachycardia recurrences.
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Key Words
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