Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1980 Sep;44(3):240–247. doi: 10.1136/hrt.44.3.240

Response of atrial flutter to overdrive atrial pacing and intravenous disopyramide phosphate, singly and in combination.

J Camm, D Ward, R Spurrell
PMCID: PMC482392  PMID: 7426181

Abstract

Ten patients who suffered spontaneous paroxysms of atrial flutter were investigated by electrophysiological techniques. Two had overt Wolff-Parkinson-White syndrome; three Lown-Ganong-Levine syndrome; and one a concealed accessory atrioventricular connection. Atrial flutter was initiated, at study, by right atrial pacing and electrograms from the right atrium and coronary sinus were observed for at least five minutes to ensure stable flutter in both atria. Atrial flutter was terminated by 2.5 s or 5 s bursts of atrial pacing at rates 10, 50, or 100 beats/min faster than the intrinsic flutter rate in only two patients. Atrial flutter, which was reinitiated in two patients, was then treated with intravenous disopyramide phosphate, 2 mg/kg body weight, infused over five minutes. In all 10 patients the atrial rate slowed from a mean of 310 +/- 39 beats/min to 217 +/- 27 beats/min and atrial flutter terminated in one case. Though the mean ventricular rate fell from 161 +/- 52 beats/min to 156 +/- 45 beats/min the atrioventricular conduction ratio fell from 2.17 +/- 0.86 to 1.55 +/- 0.59 and four patients were left with symptomatically significant increases of ventricular rate. In seven of nine patients overdrive atrial pacing, repeated after disopryamide, resulted in the conversion of atrial flutter to sinus rhythm. In this study, overdrive atrial pacing and intravenous disopyramide, singly and in combination, terminated atrial flutter in nine of the 10 patients and it is suggested that this method may provide an effective alternative to direct current cardioversion.

Full text

PDF
240

Selected References

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

  1. ACIERNO L. J., GUBNER R. Utility and limitations of intravenous quinidine in arrhythmias. Am Heart J. 1951 May;41(5):733–741. doi: 10.1016/0002-8703(51)90262-1. [DOI] [PubMed] [Google Scholar]
  2. BROWN B. B. A study of factors related to effects of quinidine in experimental auricular flutter. Circulation. 1952 Jun;5(6):864–869. doi: 10.1161/01.cir.5.6.864. [DOI] [PubMed] [Google Scholar]
  3. Birkhead J. S., Vaughan Williams E. M. Dual effect of disopyramide on atrial and atrioventricular conduction and refractory periods. Br Heart J. 1977 Jun;39(6):657–660. doi: 10.1136/hrt.39.6.657. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CASTELLANOS A., Jr, GOSSELIN A., FONSECA E. J. EVALUATION OF COUNTERSHOCK TREATMENT OF ATRIAL FLUTTER. WITH SPECIAL REFERENCE TO ARRHYTHMIAS RELATED TO THIS PROCEDURE. Arch Intern Med. 1965 Apr;115:426–433. doi: 10.1001/archinte.1965.03860160052009. [DOI] [PubMed] [Google Scholar]
  5. Camm A. J., Ward D. E., Spurrell R. A. Gaps in anterograde conduction in patients with the short PR interval, normal QRS complex syndrome. Br Heart J. 1978 Oct;40(10):1119–1126. doi: 10.1136/hrt.40.10.1119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Camm J., Ward D., Spurrell R. A. The effect of intravenous disopyramide phosphate on recurrent paroxysmal tachycardias. Br J Clin Pharmacol. 1979 Nov;8(5):441–449. doi: 10.1111/j.1365-2125.1979.tb01023.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cheng T. O. Atrial pacing: its diagnostic and therapeutic applications. Prog Cardiovasc Dis. 1971 Sep;14(2):230–247. doi: 10.1016/0033-0620(71)90056-9. [DOI] [PubMed] [Google Scholar]
  8. Cheng T. O. Rapid atrial pacing in conversion of atrial flutter. Am J Cardiol. 1973 Feb;31(2):287–287. doi: 10.1016/0002-9149(73)91044-8. [DOI] [PubMed] [Google Scholar]
  9. Deano D. A., Wu D., Mautner R. K., Sherman R. H., Ehsani A. I., Rosen K. M. The antiarrhythmic efficacy of intravenous therapy with disopyramide phosphate. Chest. 1977 May;71(5):597–606. doi: 10.1378/chest.71.5.597. [DOI] [PubMed] [Google Scholar]
  10. Durrer D., Schoo L., Schuilenburg R. M., Wellens H. J. The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation. 1967 Nov;36(5):644–662. doi: 10.1161/01.cir.36.5.644. [DOI] [PubMed] [Google Scholar]
  11. Gianelly R., Griffin J. R., Harrison D. C. Propranolol in the treatment and prevention of cardiac arrhythmias. Ann Intern Med. 1967 Apr;66(4):667–676. doi: 10.7326/0003-4819-66-4-667. [DOI] [PubMed] [Google Scholar]
  12. Gough W., Dreifus L. S., de Azevedo I. M., Katz M. R. Refractoriness of cardiac tissue. Cardiovasc Clin. 1974;6(1):87–97. [PubMed] [Google Scholar]
  13. Gulotta S. J., Aronson A. L. Cardioversion of atrial tachycardia and flutter by atrial stimulation. Am J Cardiol. 1970 Sep;26(3):262–269. doi: 10.1016/0002-9149(70)90793-9. [DOI] [PubMed] [Google Scholar]
  14. Haft J. I., Kosowsky B. D., Lau S. H., Stein E., Damato A. N. Termination of atrial flutter by rapid electrical pacing of the atrium. Am J Cardiol. 1967 Aug;20(2):239–244. doi: 10.1016/0002-9149(67)90084-7. [DOI] [PubMed] [Google Scholar]
  15. Hunt N. C., Cobb F. R., Waxman M. B., Zeft H. J., Peter R. H., Morris J. J., Jr Conversion of supraventricular tachycardias with atrial stimulation. Evidence for re-entry mechanisms. Circulation. 1968 Dec;38(6):1060–1065. doi: 10.1161/01.cir.38.6.1060. [DOI] [PubMed] [Google Scholar]
  16. Lister J. W., Cohen L. S., Bernstein W. H., Samet P. Treatment of supraventricular tachycardias by rapid atrial stimulation. Circulation. 1968 Dec;38(6):1044–1059. doi: 10.1161/01.cir.38.6.1044. [DOI] [PubMed] [Google Scholar]
  17. Lown B., Kleiger R., Williams J. Cardioversion and digitalis drugs: changed threshold to electric shock in digitalized animals. Circ Res. 1965 Dec;17(6):519–531. doi: 10.1161/01.res.17.6.519. [DOI] [PubMed] [Google Scholar]
  18. Luoma P. V., Kujala P. A., Juustila H. J., Takkunen J. T. Efficacy of intravenous disopyramide in the termination of supraventricular arrhythmias. J Clin Pharmacol. 1978 May-Jun;18(5-6):293–301. doi: 10.1002/j.1552-4604.1978.tb02449.x. [DOI] [PubMed] [Google Scholar]
  19. MARQUES M. G., MOTA J. C., NOGUEIRA R. A. The mechanism of atrial flutter. Cardiologia. 1962;40:269–280. doi: 10.1159/000167411. [DOI] [PubMed] [Google Scholar]
  20. MILLER G., WEINBERG S. L., PICK A. The effect of procaine amide (pronestyl) in clinical auricular fibrillation and flutter. Circulation. 1952 Jul;6(1):41–50. doi: 10.1161/01.cir.6.1.41. [DOI] [PubMed] [Google Scholar]
  21. Massumi R. A., Kistin A. D., Tawakkol A. A. Termination of reciprocating tachycardia by atrial stimulation. Circulation. 1967 Nov;36(5):637–643. doi: 10.1161/01.cir.36.5.637. [DOI] [PubMed] [Google Scholar]
  22. Orlando J., Cassidy J., Aronow W. S. High reversion of atrial flutter to sinus rhythm after atrial pacing in patients with pulmonary disease. Chest. 1977 May;71(5):580–582. doi: 10.1378/chest.71.5.580. [DOI] [PubMed] [Google Scholar]
  23. PRINZMETAL M., GOLDMAN A., GERLACH E., KENNAMER R. Nature of spontaneous auricular flutter in man; report of a case observed directly during cardiac surgery. J Am Med Assoc. 1953 Oct 10;153(6):553–555. doi: 10.1001/jama.1953.02940230025006e. [DOI] [PubMed] [Google Scholar]
  24. Pittman D. E., Gay T. C., Patel I. I., Joyner C. R. Termination of atrial flutter and atrial tachycardia with rapid atrial stimulation. Angiology. 1975 Dec;26(11):784–802. doi: 10.1177/000331977502601102. [DOI] [PubMed] [Google Scholar]
  25. Pittman D. E., Makar J. S., Kooros K. S., Joyner C. R. Rapid atrial stimulation: successful method of conversion of atrial flutter and atrial tachycardia. Am J Cardiol. 1973 Oct;32(5):700–706. doi: 10.1016/s0002-9149(73)80065-7. [DOI] [PubMed] [Google Scholar]
  26. Puech P., Grolleau R., Latour H., Cabasson J., Robin J. M., Baissus C. Traitement du flutter auriculaire par la stimulation auriculaire endocavitaire. Arch Mal Coeur Vaiss. 1973 Feb;66(2):159–167. [PubMed] [Google Scholar]
  27. RABBINO M. D., LIKOFF W., DREIFUS L. S. COMPLICATIONS AND LIMITATIONS OF DIRECT-CURRENT COUNTERSHOCK. JAMA. 1964 Nov 2;190:417–420. doi: 10.1001/jama.1964.03070180015003. [DOI] [PubMed] [Google Scholar]
  28. Rosen K. M., Sinno M. Z., Gunnar R. M., Rahimtoola S. H. Failure of rapid atrial pacing in the conversion of atrial flutter. Am J Cardiol. 1972 Apr;29(4):524–528. doi: 10.1016/0002-9149(72)90443-2. [DOI] [PubMed] [Google Scholar]
  29. Rytand D. A. The circus movement (entrapped circuit wave) hypothesis and atrial flutter. Ann Intern Med. 1966 Jul;65(1):125–159. doi: 10.7326/0003-4819-65-1-125. [DOI] [PubMed] [Google Scholar]
  30. SEKIYA A., VAUGHANWILLIAMS E. M. A COMPARISON OF THE ANTIFIBRILLATORY ACTIONS AND EFFECTS ON INTRACELLULAR CARDIAC POTENTIALS OF PRONETHALOL, DISOPYRAMIDE AND QUINIDINE. Br J Pharmacol Chemother. 1963 Dec;21:473–481. doi: 10.1111/j.1476-5381.1963.tb02015.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Schamroth L., Krikler D. M., Garrett C. Immediate effects of intravenous verapamil in cardiac arrhythmias. Br Med J. 1972 Mar 11;1(5801):660–662. doi: 10.1136/bmj.1.5801.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Scherf D. The mechanism of flutter and fibrillation. Am Heart J. 1966 Feb;71(2):273–280. doi: 10.1016/0002-8703(66)90191-8. [DOI] [PubMed] [Google Scholar]
  33. Spurrell R. A., Thorburn C. W., Camm J., Sowton E., Deuchar D. C. Effects of disopyramide on electrophysiological properties of specialized conduction system in man and on accessory atrioventricular pathway in Wolff-Parkinson-White syndrome. Br Heart J. 1975 Aug;37(8):861–867. doi: 10.1136/hrt.37.8.861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Vandenbosch R., Lisin N., Andriange M., Gach J., Carlier J. Experimentation clinique du disopyramide administre par voie intraveineuse. Acta Cardiol. 1975;30(4):267–278. [PubMed] [Google Scholar]
  35. Vergara G. S., Hildner F. J., Schoenfeld C. B., Javier R. P., Cohen L. S., Samet P. Conversion of supraventricular tachycardias with rapid atrial stimulation. Circulation. 1972 Oct;46(4):788–793. doi: 10.1161/01.cir.46.4.788. [DOI] [PubMed] [Google Scholar]
  36. Waldo A. L., MacLean W. A., Karp R. B., Kouchoukos N. T., James T. N. Entrainment and interruption of atrial flutter with atrial pacing: studies in man following open heart surgery. Circulation. 1977 Nov;56(5):737–745. doi: 10.1161/01.cir.56.5.737. [DOI] [PubMed] [Google Scholar]
  37. Ward D. E., Camm A. J., Spurrell R. A. The response of regular re-entrant supraventricular tachycardia to right heart stimulation. Pacing Clin Electrophysiol. 1979 Nov;2(6):586–595. doi: 10.1111/j.1540-8159.1979.tb04277.x. [DOI] [PubMed] [Google Scholar]
  38. Wit A. L., Cranefield P. F. Triggered activity in cardiac muscle fibers of the simian mitral valve. Circ Res. 1976 Feb;38(2):85–98. doi: 10.1161/01.res.38.2.85. [DOI] [PubMed] [Google Scholar]
  39. Wyndham C. R., Wu D., Denes P., Sugarman D., Levitsky S., Rosen K. M. Self-initiated conversion of paroxysmal atrial flutter utilizing a radio-frequency pacemaker. Am J Cardiol. 1978 May 22;41(6):1119–1122. doi: 10.1016/0002-9149(78)90867-6. [DOI] [PubMed] [Google Scholar]
  40. Zeft H. J., Cobb F. R., Waxman M. B., Hunt N. C., Morris J. J., Jr Right atrial stimulation in the treatment of atrial flutter. Ann Intern Med. 1969 Mar;70(3):447–456. doi: 10.7326/0003-4819-70-3-447. [DOI] [PubMed] [Google Scholar]

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

RESOURCES