Verapamil in Tachycardia Therapy

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Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. Recently, there has been an interest in the potential benefits of therapy with verapamil for multifocal atrial tachycardia. Doctors Levine, Michael, and Guarnieri1Levine JH Michael JR Guarnieri T Treatment of multifocal atrial tachycardia with verapamil.New Engl J Med. 1985; 312: 21-25Crossref PubMed Scopus (69) Google Scholar found therapy with verapamil, given both intravenously and orally, to be effective in reducing atrial and ventricular rates in multifocal atrial tachycardia, and it even occasionally converts this arrhythmia to sinus rhythm. Aronow et al2Aronow WS, Plasencia G, Wong R, Landa D, Karlsberg R, Felinz J. Effect of verapamil versus placebo on PAT and MAT (paroxysmal atrial tachycardia and multifocal atrial tachycardia). Curr Ther Res 27; 6:823-29Google Scholar reported negative results where “neither verapamil nor intravenous saline was very effective in treating multifocal atrial tachycardia.” Our experience with oral verapamil treatment is consistent with that of Doctor Levine and co-workers. We recently saw four chronic pulmonary disease patients who were noted to have multifocal atrial tachycardia on electrocardiographic examination performed routinely or for evaluation of symptoms including dyspnea, chest pain and palpitations. The criteria used to diagnose multifocal atrial tachycardia were: 1) atrial and ventricular rates greater than 100 beats/min, 2) the presence of at least three different p-wave forms, and 3) at least three variable p-p intervals and three variable p-r intervals.3Shine KI Kastor JA Yurchak PM Multifocal atrial tachycardia: clinical and electrocardiogram features in 32 patients.New Engl J Med. 1968; 279 (344–49)Crossref PubMed Scopus (81) Google Scholar, 4Cheng TO Multifocal atrial dysrhythmia.New Engl J Med. 1969; 282: 104Google Scholar These patients were monitored for at least twelve hours prior to receiving therapy with oral verapamil. Verapamil treatment was begun at a dose of 80 mg orally every eight hours, and Holter monitoring was performed within 72 hours. The patients were not started on therapy with any new anti-arrhythmic medications other than those they were receiving prior to multifocal atrial tachycardia. We found that all three patients had slower atrial and ventricular rates (ventricular rates greater than 120 beats/min reduced to under 80 beats/min), were in sinus rhythm for longer periods, and had shorter and less-frequent episodes of all supraventricular arrhythmias, including multifocal atrial tachycardia, while on therapy with verapamil. However, this may have been due to the improvement in the patients' general condition. Therefore, therapy with verapamil was discontinued in one of the above patients, and several episodes of multifocal atrial tachycardia, some lasting 20 min, occurred within 24 hours after verapamil was discontinued.