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. 1992 May;67(5):355–360. doi: 10.1136/hrt.67.5.355

Comparative electrophysiological effects of captopril or hydralazine combined with nitrate in patients with left ventricular dysfunction and inducible ventricular tachycardia.

Y Bashir 1, J F Sneddon 1, S O'Nunain 1, V E Paul 1, S Gibson 1, D E Ward 1, A J Camm 1
PMCID: PMC1024854  PMID: 1389714

Abstract

OBJECTIVE--To assess the electrophysiological and antiarrhythmic effects of pharmacological load manipulation by an angiotensin converting enzyme (ACE) inhibitor (captopril) and a direct vasodilator (hydralazine plus isosorbide mononitrate) in patients with inducible ventricular tachycardia and impaired left ventricular function. DESIGN--Randomised open label cross-over comparison of three regimens. SETTING--Tertiary arrhythmia referral centre. SUBJECTS--Eight patients with reduced left ventricular function and sustained ventricular tachycardia inducible by programmed stimulation. INTERVENTIONS--Three treatment regimens each of 48 hours duration: captopril, hydralazine plus isosorbide mononitrate, and control (no vasodilator). MAIN OUTCOME MEASURES--Changes in central haemodynamics, electrophysiological parameters, and induction of ventricular tachycardia during treatment with captopril, or hydralazine combined with nitrate, compared with a control period. RESULTS--Both vasodilator treatments produced similar balanced reductions in peak systolic pressures and filling pressures compared with controls. Captopril had no effect on sinus cycle length, atrial refractoriness, or intraventricular conduction, but prolonged ventricular effective and functional refractory periods and QT interval during constant rate atrial pacing. Hydralazine combined with nitrate did not significantly alter any electrophysiological variable. Ventricular tachycardia was similarly inducible during all three periods. CONCLUSIONS--Load manipulation by captopril but not hydralazine combined with nitrate prolonged ventricular refractoriness and repolarisation, possibly reflecting a combination of mechano-electrical effect with the restraining influence of ACE inhibitors on reflex sympathetic stimulation.

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Selected References

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  1. Bayés de Luna A., Coumel P., Leclercq J. F. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J. 1989 Jan;117(1):151–159. doi: 10.1016/0002-8703(89)90670-4. [DOI] [PubMed] [Google Scholar]
  2. Bryant S. M., Ryder K. O., Hart G. Effects of captopril on membrane current and contraction in single ventricular myocytes from guinea-pig. Br J Pharmacol. 1991 Feb;102(2):462–466. doi: 10.1111/j.1476-5381.1991.tb12195.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bussmann W. D., Neumann K., Kaltenbach M. Effects of intravenous nitroglycerin on ventricular ectopic beats in acute myocardial infarction. Am Heart J. 1984 May;107(5 Pt 1):940–944. doi: 10.1016/0002-8703(84)90832-9. [DOI] [PubMed] [Google Scholar]
  4. Carlson M. D., Schoenfeld M. H., Garan H., Choong C. Y., Davidoff R., Weyman A. E., Ruskin J. N., Fifer M. A. Programmed ventricular stimulation in patients with left ventricular dysfunction and ventricular tachycardia: effects of acute hemodynamic improvement due to nitroprusside. J Am Coll Cardiol. 1989 Dec;14(7):1744–1752. doi: 10.1016/0735-1097(89)90026-0. [DOI] [PubMed] [Google Scholar]
  5. Cleland J. G., Dargie H. J., Hodsman G. P., Ball S. G., Robertson J. I., Morton J. J., East B. W., Robertson I., Murray G. D., Gillen G. Captopril in heart failure. A double blind controlled trial. Br Heart J. 1984 Nov;52(5):530–535. doi: 10.1136/hrt.52.5.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Clough D. P., Collis M. G., Conway J., Hatton R., Keddie J. R. Interaction of angiotensin-converting enzyme inhibitors with the function of the sympathetic nervous system. Am J Cardiol. 1982 Apr 21;49(6):1410–1414. doi: 10.1016/0002-9149(82)90352-6. [DOI] [PubMed] [Google Scholar]
  7. Cohn J. N., Archibald D. G., Ziesche S., Franciosa J. A., Harston W. E., Tristani F. E., Dunkman W. B., Jacobs W., Francis G. S., Flohr K. H. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1986 Jun 12;314(24):1547–1552. doi: 10.1056/NEJM198606123142404. [DOI] [PubMed] [Google Scholar]
  8. Cooper M. J., Koo C. C., Skinner M. P., Mortensen P. T., Hunt L. J., Richards D. A., Uther J. B., Ross D. L. Comparison of immediate versus day to day variability of ventricular tachycardia induction by programmed stimulation. J Am Coll Cardiol. 1989 Jun;13(7):1599–1607. doi: 10.1016/0735-1097(89)90354-9. [DOI] [PubMed] [Google Scholar]
  9. Daly P., Rouleau J. L., Cousineau D., Burgess J. H., Chatterjee K. Effects of captopril and a combination of hydralazine and isosorbide dinitrate on myocardial sympathetic tone in patients with severe congestive heart failure. Br Heart J. 1986 Aug;56(2):152–157. doi: 10.1136/hrt.56.2.152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Davidowski T. A., Wolf S. The QT interval during reflex cardiovascular adaptation. Circulation. 1984 Jan;69(1):22–25. doi: 10.1161/01.cir.69.1.22. [DOI] [PubMed] [Google Scholar]
  11. Dean J. W., Lab M. J. Arrhythmia in heart failure: role of mechanically induced changes in electrophysiology. Lancet. 1989 Jun 10;1(8650):1309–1312. doi: 10.1016/s0140-6736(89)92697-4. [DOI] [PubMed] [Google Scholar]
  12. Dean J. W., Lab M. J. Regional changes in ventricular excitability during load manipulation of the in situ pig heart. J Physiol. 1990 Oct;429:387–400. doi: 10.1113/jphysiol.1990.sp018263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ford L. E., Campbell N. P. Effect of myocardial shortening velocity on duration of electrical and mechanical systole. S2T interval as measure of shortening rate. Br Heart J. 1980 Aug;44(2):179–183. doi: 10.1136/hrt.44.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Francis G. S. Should asymptomatic ventricular arrhythmias in patients with congestive heart failure be treated with antiarrhythmic drugs? J Am Coll Cardiol. 1988 Jul;12(1):274–283. doi: 10.1016/0735-1097(88)90388-9. [DOI] [PubMed] [Google Scholar]
  15. Hermsmeyer K. Angiotensin II increases electrical coupling in mammalian ventricular myocardium. Circ Res. 1980 Oct;47(4):524–529. doi: 10.1161/01.res.47.4.524. [DOI] [PubMed] [Google Scholar]
  16. Kulick D. L., Bhandari A. K., Hong R., Petersen R., Leon C., Rahimtoola S. H. Effect of acute hemodynamic decompensation on electrical inducibility of ventricular arrhythmias in patients with dilated cardiomyopathy and complex nonsustained ventricular arrhythmias. Am Heart J. 1990 Apr;119(4):878–883. doi: 10.1016/s0002-8703(05)80326-6. [DOI] [PubMed] [Google Scholar]
  17. Lab M. J. Contraction-excitation feedback in myocardium. Physiological basis and clinical relevance. Circ Res. 1982 Jun;50(6):757–766. doi: 10.1161/01.res.50.6.757. [DOI] [PubMed] [Google Scholar]
  18. Levine J. H., Guarnieri T., Kadish A. H., White R. I., Calkins H., Kan J. S. Changes in myocardial repolarization in patients undergoing balloon valvuloplasty for congenital pulmonary stenosis: evidence for contraction-excitation feedback in humans. Circulation. 1988 Jan;77(1):70–77. doi: 10.1161/01.cir.77.1.70. [DOI] [PubMed] [Google Scholar]
  19. Luu M., Stevenson W. G., Stevenson L. W., Baron K., Walden J. Diverse mechanisms of unexpected cardiac arrest in advanced heart failure. Circulation. 1989 Dec;80(6):1675–1680. doi: 10.1161/01.cir.80.6.1675. [DOI] [PubMed] [Google Scholar]
  20. Moorman J. R., Kirsch G. E., Lacerda A. E., Brown A. M. Angiotensin II modulates cardiac Na+ channels in neonatal rat. Circ Res. 1989 Dec;65(6):1804–1809. doi: 10.1161/01.res.65.6.1804. [DOI] [PubMed] [Google Scholar]
  21. Packer M. Sudden unexpected death in patients with congestive heart failure: a second frontier. Circulation. 1985 Oct;72(4):681–685. doi: 10.1161/01.cir.72.4.681. [DOI] [PubMed] [Google Scholar]
  22. Taggart P., Sutton P. M., Treasure T., Lab M., O'Brien W., Runnalls M., Swanton R. H., Emanuel R. W. Monophasic action potentials at discontinuation of cardiopulmonary bypass: evidence for contraction-excitation feedback in man. Circulation. 1988 Jun;77(6):1266–1275. doi: 10.1161/01.cir.77.6.1266. [DOI] [PubMed] [Google Scholar]
  23. Webster M. W., Fitzpatrick M. A., Nicholls M. G., Ikram H., Wells J. E. Effect of enalapril on ventricular arrhythmias in congestive heart failure. Am J Cardiol. 1985 Sep 15;56(8):566–569. doi: 10.1016/0002-9149(85)91186-5. [DOI] [PubMed] [Google Scholar]
  24. de Langen C. D., de Graeff P. A., van Gilst W. H., Bel K. J., Kingma J. H., Wesseling H. Effects of angiotensin II and captopril on inducible sustained ventricular tachycardia two weeks after myocardial infarction in the pig. J Cardiovasc Pharmacol. 1989 Feb;13(2):186–191. doi: 10.1097/00005344-198902000-00002. [DOI] [PubMed] [Google Scholar]

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