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The intravenous administration of verapamil to 2 patients with paroxysmal supraventricular tachycardia (PSVT) resulted in an induction of PSVT during a programmed electrophysiological stimulation study. Each patient had a documented episode of PSVT. Baseline programmed stimulation studies revealed neither induction of PSVT nor an atrial echo; however, PSVT was induced immediately after injecting verapamil (0.15 mg/kg) intravenously in both patients. In 1 patient, the study was repeated 2 days later and similar results were obtained. The serum concentration of verapamil when PSVT was induced was about 80 ng/ml in both cases. Clinicians using verapamil should note that this antiarrhythmic drug may aggravate PSVT, depending on critical changes in AV nodal conduction and refractoriness.

The paradoxical adverse effect of verapamil for treating clinical paroxysmal supraventricular tachycardia.