Effects of verapamil on supraventricular tachycardia in children

Co burn J. Porter, Paul C. Gillette, Arthur Garson, Peter S. Hesslein, Peter P. Karpawich, Dan G. McNamara

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Thirteen patients, aged 6 weeks to 16 years, with uncontrolled recurrent Supraventricular tachycardia were given intravenous verapamil in an attempt to abolish an episode of Supraventricular tachycardia. All patients had had intracardiac electrophysiologic studies to define the mechanism of their tachycardia. In seven patients conversion to sinus rhythm occurred after administration of verapamil: Five of the seven had atrioventricular (A-V) nodal reentry as the mechanism of their supraventricular tachycardia; the other two had reentrant tachycardia involving an accessory pathway. Verapamil was effective in abolishing the Supraventricular tachycardia in these patients, probably by prolonging the A-V nodal refractory period and conduction, thus breaking the reentrant circuit. In six patients there was no conversion to sinus rhythm: Four of the six had automatic atrial ectopic tachycardia and two had automatic junctional ectopic tachycardia. Among the four patients with automatic atrial ectopic tachycardia, a junctional escape rhythm developed in one, and second degree A-V block developed in the others. The two patients with junctional ectopic tachycardia had severe symptomatic arterial hypotension after verapamil and required resuscitation with intravenous calcium chloride. In spite of the good response to intravenous verapamil in the seven patients with reentrant tachycardia, only four of the seven could be maintained successfully on long-term oral therapy. The patients who experienced conversion to sinus rhythm with an intravenous bolus dose of verapamil but in whom Supraventricular tachycardia could still be induced with programmed stimulation could not be maintained successfully on oral therapy. It is concluded that verapamil is an effective antiarrhythmic agent that can (1) abolish the acute episode of Supraventricular tachycardia only in cases due to reentrant mechanisms, and (2) be used as an oral medication to prevent recurrences of supraventricular tachycardia in patients in whom the arrhythmia cannot be induced with programmed stimulation after intravenous doses of the drug.

Original languageEnglish
Pages (from-to)487-491
Number of pages5
JournalThe American Journal of Cardiology
Issue number3
StatePublished - Sep 1981


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