Electrophysiologic effects of intravenous timolol

Abstract

We evaluated the electrophysiologic effects and dose response of the long-acting beta-blocking drug timolol given intravenously to 12 patients during intracardiac electrophysiologic study. Electrophysiologic parameters were measured during control and immediately, 30 minutes, and 48 hours following infusion. Significant changes in electrophysiologic parameters were only observed in the five patients (Group B) who received 0.05 mg/kg and not in the seven patients who received 0.02 mg/kg (Group A). In Group B patients immediately after timolol infusion sinus cycle length increased from 840 ± 254 msec to 1048 ± 63 msec ( P<0.01), A-H interval during normal sinus rhythm increased from 94 ± 42 msec to 101 ± 45 msec ( P<0.05), paced cycle length to A-V nodal Wenckebach increased from 370 ± 45 msec to 430 ± 76 msec ( P<0.05), and A-V nodal effective refractory period increased from 284 ± 63 msec to 360 ± 83 msec ( P<0.01). Significant increases in these electrophysiologic parameters were also noted at 30 minutes following timolol infusion. Other conduction times, atrial and ventricular refractory periods, and corrected sinus node recovery time were unaltered by timolol. All electrophysiologic parameters returned to control in 48 hours. No adverse effects were observed. We conclude that intravenous timolol in doses of 0.05 mg/kg significantly increases sinus cycle length and prolongs A-V nodal conduction and refractoriness, demonstrates peak effects immediately after intravenous administration, and is well tolerated.