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Edrophonium‐Induced Right Ventricular Outflow Tract Tachycardia
Author(s) -
HACHIYA HITOSHI,
AONUMA KAZUTAKA,
YAMAUCHI YASUTERU,
SEKIGUCHI YUKIO,
IESAKA YOSHITO
Publication year - 2005
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2005.00007.x
Subject(s) - medicine , ventricular tachycardia , cardiology , ventricular outflow tract , ambulatory , anesthesia , tachycardia , provocation test , electrocardiography , autonomic nervous system , heart rate , blood pressure , alternative medicine , pathology
Idiopathic right ventricular outflow tract‐ventricular tachycardia (RVOT‐VT) generally occurs when sympathetic nervous system activity is increased, though, in a few patients, it develops when parasympathetic nervous activity (PNA) is increased. Among 101 consecutive patients with RVOT‐VT confirmed by endocardial catheter mapping, 5 (4.9%) presented with nocturnal RVOT‐VT. Autonomic nervous balance was studied by heart rate variability (HRV) analysis from 24‐hour ambulatory electrocardiogram (ECG). Standard programmed ventricular stimulation (PVS), ventricular burst pacing, and drug provocation were performed to induce RVOT‐VT. In the studied five patients, the average number of mostly nocturnal ventricular premature contractions (VPCs) was 6649 ± 4472/day. Two patients had nocturnal nonsustained RVOT‐VT on 24‐hour ambulatory ECG recordings. The HRV analysis revealed that a progressive increase in high‐frequency power coincided with an increase in VPCs or development of RVOT‐VT at night, whereas low/high frequency ratio did not change significantly during the 24‐hour period. RVOT‐VT could not be induced by PVS, ventricular burst pacing, or isoproterenol or adenosine triphosphate i.v. However, RVOT‐VT could only be induced by edrophonium, 5 mg i.v., in all patients. An increase in PNA was observed in a few patients before the development of RVOT‐VT. Edrophonium facilitated induction of RVOT‐VT in such patients.