Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1989 Mar;61(3):268–273. doi: 10.1136/hrt.61.3.268

Electrophysiological study of young patients with exercise related paroxysms of palpitation: role of atropine and isoprenaline for initiation of supraventricular tachycardia.

I Toda 1, T Kawahara 1, Y Murakawa 1, A Nozaki 1, K Kawakubo 1, H Inoue 1, T Sugimoto 1
PMCID: PMC1216656  PMID: 2930664

Abstract

Electrophysiological studies were performed in eight patients (four men and four women, mean (SD) age 24 (5) years with paroxysmal attacks of palpitation during or immediately after exercise. Five patients were competitive athletes at college. In two patients spontaneous supraventricular tachycardia during exercise was recorded by ambulatory electrocardiographic monitoring and in another it was induced by treadmill exercise testing. Two had dual atrioventricular nodal pathways, three had manifest atrioventricular accessory pathways, and three had concealed atrioventricular pathways. Programmed stimulation induced sustained supraventricular tachycardia in six patients--in two after intravenous injection of atropine sulphate (1 mg) and in four during infusion of isoprenaline (0.01 microgram/kg/min). In one patient, non-sustained atrioventricular nodal reentrant tachycardia was induced during isoprenaline infusion. In the remaining patient, who had dual atrioventricular nodal pathways, tachycardia was not inducible. AH block prevented maintenance of reentry in five patients. In five patients shortening of the effective refractory period of the atrioventricular node with atropine (one patient) and isoprenaline (four patients) caused sustained supraventricular tachycardia. The present study indicates that treatment with atropine and isoprenaline may be an important factor in the initiation of supraventricular tachycardia in patients with exercise related paroxysms of palpitation.

Full text

PDF
268

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akhtar M. Atrioventricular nodal reentrant tachycardia. Med Clin North Am. 1984 Jul;68(4):819–830. doi: 10.1016/s0025-7125(16)31103-8. [DOI] [PubMed] [Google Scholar]
  2. Akhtar M., Damato A. N., Batsford W. P., Caracta A. R., Ruskin J. N., Weisfogel G. M., Lau S. H. Induction of atrioventricular nodal reentrant tachycardia after atropine. Report of five cases. Am J Cardiol. 1975 Sep;36(3):286–291. doi: 10.1016/0002-9149(75)90477-4. [DOI] [PubMed] [Google Scholar]
  3. Binkley P. F., Bush C. A., Fleishman B. L., Leier C. V. In vivo validation of the origin of the esophageal electrocardiogram. J Am Coll Cardiol. 1986 Apr;7(4):813–818. doi: 10.1016/s0735-1097(86)80341-2. [DOI] [PubMed] [Google Scholar]
  4. Brugada P., Facchini M., Wellens H. J. Effects of isoproterenol and amiodarone and the role of exercise in initiation of circus movement tachycardia in the accessory atrioventricular pathway. Am J Cardiol. 1986 Jan 1;57(1):146–149. doi: 10.1016/0002-9149(86)90969-0. [DOI] [PubMed] [Google Scholar]
  5. Coelho A., Palileo E., Ashley W., Swiryn S., Petropoulos A. T., Welch W. J., Bauernfeind R. A. Tachyarrhythmias in young athletes. J Am Coll Cardiol. 1986 Jan;7(1):237–243. doi: 10.1016/s0735-1097(86)80287-x. [DOI] [PubMed] [Google Scholar]
  6. Denes P., Wu D., Dhingra R., Pietras R. J., Rosen K. M. The effects of cycle length on cardiac refractory periods in man. Circulation. 1974 Jan;49(1):32–41. doi: 10.1161/01.cir.49.1.32. [DOI] [PubMed] [Google Scholar]
  7. Hariman R. J., Gomes J. A., El-Sherif N. Catecholamine-dependent atrioventricular nodal reentrant tachycardia. Circulation. 1983 Mar;67(3):681–686. doi: 10.1161/01.cir.67.3.681. [DOI] [PubMed] [Google Scholar]
  8. Lichtman J., O'Rourke R. A., Klein A., Karliner J. S. Electrocardiogram of the athlete. Alterations simulating those of organic heart disease. Arch Intern Med. 1973 Nov;132(5):763–770. [PubMed] [Google Scholar]
  9. McHenry P. L., Fisch C., Jordan J. W., Corya B. R. Cardiac arrhythmias observed during maximal treadmill exercise testing in clinically normal men. Am J Cardiol. 1972 Mar;29(3):331–336. doi: 10.1016/0002-9149(72)90527-9. [DOI] [PubMed] [Google Scholar]
  10. Murayama M., Shimomura K. Exercise and arrhythmia. Jpn Circ J. 1979 Mar;43(3):247–256. [PubMed] [Google Scholar]
  11. Prystowsky E. N., Miles W. M., Heger J. J., Zipes D. P. Preexcitation syndromes. Mechanisms and management. Med Clin North Am. 1984 Jul;68(4):831–893. doi: 10.1016/s0025-7125(16)31104-x. [DOI] [PubMed] [Google Scholar]
  12. Strasberg B., Ashley W. W., Wyndham C. R., Bauernfeind R. A., Swiryn S. P., Dhingra R. C., Rosen K. M. Treadmill exercise testing in the Wolff-Parkinson-White syndrome. Am J Cardiol. 1980 Apr;45(4):742–748. doi: 10.1016/0002-9149(80)90116-2. [DOI] [PubMed] [Google Scholar]
  13. Talan D. A., Bauernfeind R. A., Ashley W. W., Kanakis C., Jr, Rosen K. M. Twenty-four hour continuous ECG recordings in long-distance runners. Chest. 1982 Jul;82(1):19–24. doi: 10.1378/chest.82.1.19. [DOI] [PubMed] [Google Scholar]
  14. Yeh S. J., Lin F. C., Wu D. Exercise provocation of multiple reentrant tachycardias in a patient with permanent form of junctional tachycardia and intermittent ventricular preexcitation. Am Heart J. 1986 Nov;112(5):1109–1114. doi: 10.1016/0002-8703(86)90335-2. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES