Postrepolarization refractoriness versus conduction slowing caused by class I antiarrhythmic drugs : Antiarrhythmic and proarrhythmic effects
Conduction block may be both antiarrhythmic and proarrhythmic. Drug-induced postrepolarization refractoriness (PRR) may prevent premature excitation and tachyarrhythmia induction. The effects of propafenone and procainamide on these parameters, and their antiarrhythmic or proarrhythmic consequences,...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1998-06, Vol.97 (25), p.2567-2574 |
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| creator | KIRCHHOF, P. F FABRITZ, C. L FRANZ, M. R |
| description | Conduction block may be both antiarrhythmic and proarrhythmic. Drug-induced postrepolarization refractoriness (PRR) may prevent premature excitation and tachyarrhythmia induction. The effects of propafenone and procainamide on these parameters, and their antiarrhythmic or proarrhythmic consequences, were investigated.
In 11 isolated Langendorff-perfused rabbit hearts, monophasic action potentials (MAPs) were recorded simultaneously from six to seven different right and left ventricular sites, along with a volume-conducted ECG. All recordings were used to discern ventricular tachycardia (VT) or ventricular fibrillation (VF) induced by repetitive extrastimulation (S2-S5) or 10-second burst stimulation at 25 to 200 Hz at baseline and after addition of procainamide (20 micromol/L) or propafenone (1 micromol/L) to the perfusate. MAPs were analyzed for action potential duration at 90% repolarization (APD90), conduction times (CT) between the pacing site and the other MAPs, and PRR (effective refractory period-APD90=PRR) and related to the induction of VT or VF. During steady-state pacing, procainamide and propafenone prolonged APD90 by 12% and 14%, respectively. Procainamide slowed mean CT by 40% during S2-S5 pacing, whereas propafenone slowed mean CT by up to 400% (P |
| doi_str_mv | 10.1161/01.CIR.97.25.2567 |
| format | Article |
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In 11 isolated Langendorff-perfused rabbit hearts, monophasic action potentials (MAPs) were recorded simultaneously from six to seven different right and left ventricular sites, along with a volume-conducted ECG. All recordings were used to discern ventricular tachycardia (VT) or ventricular fibrillation (VF) induced by repetitive extrastimulation (S2-S5) or 10-second burst stimulation at 25 to 200 Hz at baseline and after addition of procainamide (20 micromol/L) or propafenone (1 micromol/L) to the perfusate. MAPs were analyzed for action potential duration at 90% repolarization (APD90), conduction times (CT) between the pacing site and the other MAPs, and PRR (effective refractory period-APD90=PRR) and related to the induction of VT or VF. During steady-state pacing, procainamide and propafenone prolonged APD90 by 12% and 14%, respectively. Procainamide slowed mean CT by 40% during S2-S5 pacing, whereas propafenone slowed mean CT by up to 400% (P<0.001 versus baseline and procainamide). Wavelength was not changed significantly by procainamide but was shortened fourfold by propafenone at S5. Both drugs produced PRR, which was associated with a 70% decrease in VF inducibility with procainamide and elimination of VF with propafenone. Despite this protection from VF, monomorphic VT was induced with propafenone in 57% of burst stimulations.
Drug-induced PRR protects against VF induction. Propafenone promotes slow monomorphic VT, probably by use-dependent conduction slowing and wavelength shortening.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.97.25.2567</identifier><identifier>PMID: 9657478</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Action Potentials - drug effects ; Animals ; Anti-Arrhythmia Agents - pharmacology ; Antiarrhythmics ; Arrhythmias, Cardiac - chemically induced ; Biological and medical sciences ; Confounding Factors (Epidemiology) ; Drug toxicity and drugs side effects treatment ; Electrocardiography - drug effects ; Heart Conduction System - drug effects ; In Vitro Techniques ; Medical sciences ; Myocardial Contraction - drug effects ; Pharmacology. Drug treatments ; Procainamide - pharmacology ; Propafenone - pharmacology ; Rabbits ; Toxicity: cardiovascular system</subject><ispartof>Circulation (New York, N.Y.), 1998-06, Vol.97 (25), p.2567-2574</ispartof><rights>1998 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Jun 30, 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c346t-61da200cb6b5524194cace9bff741f13b10e24c2104aec28e18e6cad955471743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,3676,27911,27912</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2313545$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9657478$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KIRCHHOF, P. F</creatorcontrib><creatorcontrib>FABRITZ, C. L</creatorcontrib><creatorcontrib>FRANZ, M. R</creatorcontrib><title>Postrepolarization refractoriness versus conduction slowing caused by class I antiarrhythmic drugs : Antiarrhythmic and proarrhythmic effects</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Conduction block may be both antiarrhythmic and proarrhythmic. Drug-induced postrepolarization refractoriness (PRR) may prevent premature excitation and tachyarrhythmia induction. The effects of propafenone and procainamide on these parameters, and their antiarrhythmic or proarrhythmic consequences, were investigated.
In 11 isolated Langendorff-perfused rabbit hearts, monophasic action potentials (MAPs) were recorded simultaneously from six to seven different right and left ventricular sites, along with a volume-conducted ECG. All recordings were used to discern ventricular tachycardia (VT) or ventricular fibrillation (VF) induced by repetitive extrastimulation (S2-S5) or 10-second burst stimulation at 25 to 200 Hz at baseline and after addition of procainamide (20 micromol/L) or propafenone (1 micromol/L) to the perfusate. MAPs were analyzed for action potential duration at 90% repolarization (APD90), conduction times (CT) between the pacing site and the other MAPs, and PRR (effective refractory period-APD90=PRR) and related to the induction of VT or VF. During steady-state pacing, procainamide and propafenone prolonged APD90 by 12% and 14%, respectively. Procainamide slowed mean CT by 40% during S2-S5 pacing, whereas propafenone slowed mean CT by up to 400% (P<0.001 versus baseline and procainamide). Wavelength was not changed significantly by procainamide but was shortened fourfold by propafenone at S5. Both drugs produced PRR, which was associated with a 70% decrease in VF inducibility with procainamide and elimination of VF with propafenone. Despite this protection from VF, monomorphic VT was induced with propafenone in 57% of burst stimulations.
Drug-induced PRR protects against VF induction. Propafenone promotes slow monomorphic VT, probably by use-dependent conduction slowing and wavelength shortening.</description><subject>Action Potentials - drug effects</subject><subject>Animals</subject><subject>Anti-Arrhythmia Agents - pharmacology</subject><subject>Antiarrhythmics</subject><subject>Arrhythmias, Cardiac - chemically induced</subject><subject>Biological and medical sciences</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Drug toxicity and drugs side effects treatment</subject><subject>Electrocardiography - drug effects</subject><subject>Heart Conduction System - drug effects</subject><subject>In Vitro Techniques</subject><subject>Medical sciences</subject><subject>Myocardial Contraction - drug effects</subject><subject>Pharmacology. Drug treatments</subject><subject>Procainamide - pharmacology</subject><subject>Propafenone - pharmacology</subject><subject>Rabbits</subject><subject>Toxicity: cardiovascular system</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkV9rFDEQwINU6ln9AD4Iofi6ZyZ_Npe-laPqQUGR9jlkZ7Ptlr3NNbPbcn4Hv7OpPYpCIGTmNzPJL4x9ALEEqOGzgOV683Pp7FKasmr7ii3ASF1po9wRWwghXGWVlG_YW6K7cqyVNcfs2NXGartasN8_Ek057tIQcv8rTH0aeY5dDjil3I-RiD_ETDNxTGM741-AhvTYjzccw0yx5c2e4xAKueFhnPqQ8-1-ut32yNs83xA_4-f_h8PY8l1O_0Ri10Wc6B173YWB4vvDfsKuv1xcrb9Vl9-_btbnlxUqXU9VDW2QQmBTN6a8FpzGgNE1XWc1dKAaEFFqlCB0iChXEVaxxtA6Y7QFq9UJO33uW25xP0ea_F2a81hGegnSKqGMKxA8Q5gTUZHid7nfhrz3IPyTfi_AF_3eWS-Nf9Jfaj4eGs_NNrYvFQffJf_pkA-EYSieR-zpBZMKlCl_9wfWO5En</recordid><startdate>19980630</startdate><enddate>19980630</enddate><creator>KIRCHHOF, P. F</creator><creator>FABRITZ, C. L</creator><creator>FRANZ, M. R</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope></search><sort><creationdate>19980630</creationdate><title>Postrepolarization refractoriness versus conduction slowing caused by class I antiarrhythmic drugs : Antiarrhythmic and proarrhythmic effects</title><author>KIRCHHOF, P. F ; FABRITZ, C. L ; FRANZ, M. R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c346t-61da200cb6b5524194cace9bff741f13b10e24c2104aec28e18e6cad955471743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Action Potentials - drug effects</topic><topic>Animals</topic><topic>Anti-Arrhythmia Agents - pharmacology</topic><topic>Antiarrhythmics</topic><topic>Arrhythmias, Cardiac - chemically induced</topic><topic>Biological and medical sciences</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Drug toxicity and drugs side effects treatment</topic><topic>Electrocardiography - drug effects</topic><topic>Heart Conduction System - drug effects</topic><topic>In Vitro Techniques</topic><topic>Medical sciences</topic><topic>Myocardial Contraction - drug effects</topic><topic>Pharmacology. Drug treatments</topic><topic>Procainamide - pharmacology</topic><topic>Propafenone - pharmacology</topic><topic>Rabbits</topic><topic>Toxicity: cardiovascular system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KIRCHHOF, P. F</creatorcontrib><creatorcontrib>FABRITZ, C. L</creatorcontrib><creatorcontrib>FRANZ, M. R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KIRCHHOF, P. F</au><au>FABRITZ, C. L</au><au>FRANZ, M. R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postrepolarization refractoriness versus conduction slowing caused by class I antiarrhythmic drugs : Antiarrhythmic and proarrhythmic effects</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1998-06-30</date><risdate>1998</risdate><volume>97</volume><issue>25</issue><spage>2567</spage><epage>2574</epage><pages>2567-2574</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Conduction block may be both antiarrhythmic and proarrhythmic. Drug-induced postrepolarization refractoriness (PRR) may prevent premature excitation and tachyarrhythmia induction. The effects of propafenone and procainamide on these parameters, and their antiarrhythmic or proarrhythmic consequences, were investigated.
In 11 isolated Langendorff-perfused rabbit hearts, monophasic action potentials (MAPs) were recorded simultaneously from six to seven different right and left ventricular sites, along with a volume-conducted ECG. All recordings were used to discern ventricular tachycardia (VT) or ventricular fibrillation (VF) induced by repetitive extrastimulation (S2-S5) or 10-second burst stimulation at 25 to 200 Hz at baseline and after addition of procainamide (20 micromol/L) or propafenone (1 micromol/L) to the perfusate. MAPs were analyzed for action potential duration at 90% repolarization (APD90), conduction times (CT) between the pacing site and the other MAPs, and PRR (effective refractory period-APD90=PRR) and related to the induction of VT or VF. During steady-state pacing, procainamide and propafenone prolonged APD90 by 12% and 14%, respectively. Procainamide slowed mean CT by 40% during S2-S5 pacing, whereas propafenone slowed mean CT by up to 400% (P<0.001 versus baseline and procainamide). Wavelength was not changed significantly by procainamide but was shortened fourfold by propafenone at S5. Both drugs produced PRR, which was associated with a 70% decrease in VF inducibility with procainamide and elimination of VF with propafenone. Despite this protection from VF, monomorphic VT was induced with propafenone in 57% of burst stimulations.
Drug-induced PRR protects against VF induction. Propafenone promotes slow monomorphic VT, probably by use-dependent conduction slowing and wavelength shortening.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9657478</pmid><doi>10.1161/01.CIR.97.25.2567</doi><tpages>8</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 1998-06, Vol.97 (25), p.2567-2574 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Action Potentials - drug effects Animals Anti-Arrhythmia Agents - pharmacology Antiarrhythmics Arrhythmias, Cardiac - chemically induced Biological and medical sciences Confounding Factors (Epidemiology) Drug toxicity and drugs side effects treatment Electrocardiography - drug effects Heart Conduction System - drug effects In Vitro Techniques Medical sciences Myocardial Contraction - drug effects Pharmacology. Drug treatments Procainamide - pharmacology Propafenone - pharmacology Rabbits Toxicity: cardiovascular system |
| title | Postrepolarization refractoriness versus conduction slowing caused by class I antiarrhythmic drugs : Antiarrhythmic and proarrhythmic effects |
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