Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome

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Abstract

The electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean+-standard deviation, baseline, 290 ± 41 ms; i.v., 355 ± 40 ms [p < 0.001]; and oral, 377 ± 33 ms [p < 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 ± 36 ms to 212 ± 35 ms with i.v. administration (p < 0.005) and 225 ± 33 ms with oral administration (p < 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 ± 47 ms; i.v., 270 ± 28 ms (p < 0.001); and oral, 323 ± 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p < 0.20), compared with a baseline mean value of 0.83 minute. Thus, (1) both i.v. and oral forms of diltiazem are effective for treating reentrant tachycardias incorporating an accessory pathway; (2) the site of action of diltiazem is mainly on anterograde atrioventricular nodal conduction; (3) the response to diltiazem given intravenously predicts the response to diltiazem given orally; (4) i.v. administration has a deleterious effect during AF and should be used cautiously; (5) diltiazem may be administered safely orally to patients with Wolff-Parkinson-White syndrome because it does not cause significant changes in the shortest and the average preexcited RR intervals during AF; (6) i.v. and oral diltiazem administration may cause AF to be sustained in some patients.

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