Cardiac Arrhythmias: Diagnosis Prognosis Therapy

243 Pages·1983·3.56 MB·English

by  Dennis Krikler (auth.)

Cardiac
Arrhythmias
Diagnosis Prognosis Therapy
Proceedings 1s t International
Rytmonorm-Congress
Edited by
M. Schlepper and B. Olsson
With 91 Figures and 67 Tables
Springer-Verlag
Berlin Heidelberg New York 1983
Professor Dr. M. Schlepper
Kerckhoff-Klinik
of the Max-Planck-Society
BenekestraBe 4-6
0-6350 Bad Nauheim
Dr. B. Olsson
Department of Cardiology
Sahlgrenska University Hospital
S-41345 Goteborg
ISBN·13: 978-3·642·68928-4 e-ISBN-13: 978-3-642-68926-0
DOl: lD/lD07/978-3-642-68926-0
Library of Congress Cataloging in Publication Data
International Rytmononn-Congress (1st: )
Cardiac arrhythmias.
1. Arrhythmia--Congresses. 2. Arrhythmia--Chemotherapy--Congresses. 3. Propafenone--
Testing--Congresses. I.Schlepper, M. (Martin), 1928- . II.Olsson, B. (Bertil), 1941-
III. Title. [DNLM: 1. Arrhythmias. WG 330 C2649] RC685.A651561983 616.1'28 83-350
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Preface
Asked to organize an international meeting on Propafenone (Ryt
monorm) we had to question ourselves, whether to accept this
offer just as interested physicians or in our capacity as chairmen of
the study group on arrhythmias and intracardiac electrography of
the European Society of Cardiology.
Considerung the "pros and contras" and well aware that one
can easily be regarded as "product promoter" we, nevertheless,
choose to organize the Symposion in association with the study
group. We felt justified to do so for a number of reasons: Arrhyth
mias and their treatment as well as the tools to detect the first and
to control the latter are well within the scope of the study group.
An international symposion provided the opportunity to have the
"state of the art" in arrhythmias and antiarrhythmic treatment
thoroughly reviewed by internationally renowned investigators,
thus serving an educational purpose.
Furthermore it was the intention and aim of the meeting to
have what is known about a fairly new drug presented in a critical
manner and to point out what is not known, but should be known.
It is in that context the presentations of the free session should
be judged. To the careful reader it will become apparent that much
which was not said, can be read "between the lines".
To "set the stage" it is of utmost importance for the organizers
not to be influenced in any way by the sponsors. It is gratefully
acknowledged that Knoll AG was not only a generous sponsor as
far as the scientific program is concerned but at no time tried to
influence or even manage contents and proceedings of the sym
posion.
It is our sincere wish for the proceedings of the symposion to
stimulate the interest in arrhythmias and their treatment, to pro
vide more information about a fairly new drug, its potential effica
cy and the indwelling danger of this and similar remedies and to
help the physician to find its proper place in a rational and, may
be, live-saving treatment for the benefit of the patients.
Martin Schlepper, MD Bertil Olsson, MD
Kerckhoff-Klinik of the Sahrgrenska University Hospital
Max -Planck-Society Goteborg/Sweden
Bad Nauheim/FRG
Table of Contens
Introduction
(D. Krikler) . 1
Differentiation Between "Normal" and "Abnormal"
in Ambulatory Electrocardiography
( P. Bjerregaard) . . . . . . . . . . . . . . . . . . . . . 3
Identification of the Patient at High Risk of Sudden Cardiac
Death
(J. Morganroth) . . . . . . . . . . . . . . . . . . . . 13
Efficacy of Oral Propafenone in Supraventricular
and Ventricular Arrhythmias: Experience with 47 Cases
(P. Coumel and J.-F. Leclercq) . . . . . . . . . . . .. 21
The Possible Relevance of Late Potentials for the
Identification of Patients Needing Antiarrhythmic Treatment
(G. Breithardt, M. Borggrefe. U. Karbenn, K. Haerten,
J. Ostermeyer and L. Seipel) .............. 37
Simulation Studies for the Interpretation of Delayed
Potentials
(R. Frank, G. Fontaine, M. Pierfitte and Y. Grosgogeat) 53
Electrophysiologic Testing in Patients with Ventricular
Tachycardia
(E. N. Prystowsky, G. V. Naccarelli, J. J. Heger and
D. P. Zipes) ... . . . . . . . . . . . . . . . . . . . . . . .. 63
Results of Invasive Methods
(H. J. Wellens) . . . . . . . . . . . . . . . . . . . . . . . . .. 71
Specific Antiarrhythmic Drugs for Specific Arrhythmias
(R. W. F. Campbell) . . . . . . . . . . . . . . . . . . . . . .. 75
Sudden Cardiac Death: Prognosis of Long-term
Antiarrhythmic Therapy
(M. Manz. G. Steinbeck and B. Luderitz) . . . . . . . . . . .. 83
Basic Electrophysiological Actions of Propafenone in Heart
Muscle
(M. Kohlhardt) ......................... 91
VIII Table of Contents
The Pharmacology of Propafenone
(H. Scholz) . ............. . . .......... 103
Clinical Pharmacology of Propafenone
(H. Neuss and M. Schlepper) . . . . . . . 113
Pharmacokinetic and Metabolic Studies on Propafenone in
Volunteers
(M. Hollmann, H. G. Hege, E. Brode, V. Biihler, D. Hotz,
S. Kaumeier, O. H. Kehrhahn, H. Lietz, J.A. Schwarz,
E. Stieren and J. Weymann) .................. 125
Effects of Propafenone on Hemodynamics and Cardiac
Inotropy
(M. Schlepper and H. Neuss) . . . . . . . . . . . . .. .. 133
Interaction Between Propafenone and Other Drugs
(K. Steinbach, K. Frohner, F. Meisl and G. Unger) . . . 141
Comparison of the Efficacy of Propafenone and Lidocaine
in Patients with Acute Myocardial Infarction and
Ventricular Extrasystoles: Result of a 24-h Holter
Monitoring
(N. Rehnqvist) . . . . . . . . . . . . . . . . . . . . . 149
Observations on the Antiarrhythmic Effects of Rytmonorm
(Ku Fu-sheng, Lin Jui-Chin, Liu Pei-Tsun, Li Qing-lang,
Chang Jang-thi, Shen Lu-hua and Yang Shi Hau) ...... 151
Comparative Study of the Therapeutic Effect
of Propafenone and Disopyramide in the Oral Treatment
of Chronic Ventricular Premature Beats
(J. Clementy, M. Dallocchio and H. Bricaud). . . . . . . . . . 159
Propafenone, Flecainide and Mexiletine in the Treatment
of Stable Ventricular Premature Beats
(H.-w. KlemptandA. Nayebagha) . . . . . . . . . . . . .. 171
Long-term Prognosis for Patients with Complex Ventricular
Arrhythmias of Lown Grades IVa and IVb
(F. Theisen, K. Theisen and H.Jahrmiirker) .......... 179
Experience with Propafenone in the Treatment
of Arrhythmias in Pediatric Patients
(H. Weber, G. Eigster and H. Wesselhoeft) ........... 185
Electrophysiologic Effects and Antiarrhythmic Efficacy of
Rytmonorm Evaluated with Programmed Electrical
Stimulation of the Heart in Patients with Recurrent
Reentrant Supraventricular Tachycardia
(A. Waleffe and H. Kulbertus) ................. 191
Table of Contents IX
Antiarrhythmic Effect and Study of Segmentary
Contractility Following the Administration of Propafenone
in Coronary Patients with Ventricular Arrhythmias
(J. L. Palma, A.Bayes de Luna, M.Fiol, P. Yuste, V. Aza,
J. Sadurni, C. E. R. y Cajal, R. Son Dureta and H. San Pablo) 199
Propafenone in Office Use: Results of an Open, Multicenter
Study
(H.-F. Spies and F. Sesto) .................... 211
The Safety and Efficacy of Propafenone in Suppressing
Ventricular Ectopy
(N. de Soyza, M. Murphy, M. Sakhaii and L. Treat) . . . . 217
Dose-Response Effect of Propafenone in Patients with
Ventricular Arrhythmias
(P. Larochelle, L. Belanger, F. Lemire, D. Phaneuf
and R. Huot) .................... ..... 221
Treatment of Severe Ventricular Arrhythmias with
Propafenone
(L. Ledain, N. Sourdille, J. P. Colle, J. Ohayon and P. Besse) . 231
Use of Propafenone for the Prevention of Ventricular
Hyperkinetic Arrhythmias in the Mitral Valve Prolapse
Syndrome
(F. Furlanello, G. B. Durante, P. Dal Forno, L. Frisanco,
G. Mosna, R. Bettini, M. Disertori, G. Vergara, A. Del Favero
and E. Stirpe) . . . . . . . . . . . . . . . . . . . . . . . . . . 237
List of Authors
V.Aza
Servicio de Cardiol., Hospital de la Santa Cruz y San Pablo, Av.
San Antonia Ma Claret 167, Barcelona 13, Spain
A. Bayes de Luna
Servicio de Cardiol., Hospital de la Santa Cruz y San Pablo, Av.
San Antonia Ma Claret 167, Barcelona 13, Spain
L.Belanger
Institut de Recherches Cliniques de Montreal, 110 avenue des
Pins ouest, Montreal, QC, H2W 1R7, Canada
P.Besse
Hopital Cardiologique, 208, avenue de Magellan, 33604 Pessac,
France
P. Bjerregaard
University Department of Cardiology, Aarhus Kommunehospi
tal, 8000 Aarhus C, Denmark
M. Borggrefe
Medizinische Klinik B, Universitat Dusseldorf, Moorenstr. 5,
4000 Dusseldorf, W. Germany
G. Breithardt
Medizinische Klinik B, Universitat Dusseldorf, Moorenstr. 5,
4000 DUsseldorf, W. Germany
H.Bricaud
Clinique Medicale Cardiologique, Hopital Cardiologique de
Bordeaux, 33604 Pessac, France
E.Brode
Knoll AG, Knollstral3e 50, 6700 Ludwigshafen, W. Germany
V. Buhler
Knoll AG, Knollstral3e 50, 6700 Ludwigshafen, W. Germany
XII List of Authors
R. W. F. Campbell
University Department of Cardiology, Freeman Hospital, New
castle upon Tyne, England, NE 7 7DN
Chang Jang-thi
Beijing Friendship Hospital, Beijing, Peoples Republic of China
J. Clementy
Clinique Medicale Cardiologique, H6pital Cardiologique de
Bordeaux, 33604 Pessac, France
J.P. Colle
H6pital Cardiologique, 208, avenue de Magellan, 33604 Pessac,
France
P.Coumel
H6pital Lariboisiere, 2 rue Ambroise-Pare, 75010 Paris, France
M. Dallocchio
Clinique Medicale Cardiologique, H6pital Cardiologique de
Bordeaux, 33604 Pessac, France
N.de Soyza
1238 Taransay Dr. Henderson, KY 42420, USA
G.Eigster
Kinderklinik und Poliklinik, Waldweg 33, 3400 Gottingen,
W.Germany
M.Hol
Servicio de Cardiol, Hospital de la Santa Cruz y San Pablo, Av.
San Antonia Ma Claret 167, Barcelona 13, Spain
G.Fontaine
H6pital Jean Rostand, 39 rue Ie Galleu, 94200 Ivry, France
R.Frank
H6pital Jean Rostand, 39 rue Ie Galleu, 94200 Ivry, France
K.Frohner
III. Medizinische Abteilung (Kardiologie und Nephrologie),
Montlearstr. 37, 1160 Wien, Austria
F. Furlanello
Division of Cardiology and Arrhythmologie Center, S. Chiara
Hospital, Trento, Italy
List of Authors XIII
Y. Grosgogeat
H6pital Jean Rostand, 39 rue Ie Galleu, 94200 Ivry, France
K.Haerten
Medizinische Klinik B, Universitat Dusseldorf, Moorenstr. 5,
4000 Dusseldorf, W. Germany
H.G.Hege
Knoll AG, Knollstr. 50, 6700 Ludwigshafen, W. Germany
J.J.Heger
Krannert Institute of Cardiology, Indiana University School of
Medicine, 1100 West Michigan Street, Indianapolis, Indiana
46223, U.S.A.
M.Hollmann
Knoll AG, KnollstraBe 50, 6700 Ludwigshafen, W. Germany
D.Hotz
Knoll AG, KnollstraBe 50, 6700 Ludwigshafen, W. Germany
R.Huot
Institut de Recherches Cliniques de Montreal, 110 avenue des
Pins ouest, Montreal, QC, H2W 1R7, Canada
H. Jahrmiirker
Medizinische Klinik, Innenstadt der Universitat Munchen,
Ziemssenstr. 1, 8000 Munchen 20, W. Germany
U.Karbenn
Medizinische Klinik B, Universitat Dusseldorf, Moorenstr. 5,
4000 Dusseldorf, W. Germany
S.Kaumeier
Knoll AG, Knollstr. 50, 6700 Ludwigshafen, W. Germany
O. H. Kehrhahn
Knoll AG, Knollstr. 50, 6700 Ludwigshafen, W. Germany
Ku Fu-sheng
Beijing Friendship Hospital, Beijing, Peoples Republik of China
XIV List of Authors
H. Kulbertus
University of Liege Medical School, Institute of Medicine, Car
diology Division, Laboratory of Cardiac Clinical Electrophysiol
ogy and Pharmacology, H6pital de Baviere, 4020 Liege, Belgium
H.-W. Klempt
Klinik Martinusquelle, An der Martinusquelle 10, 4792 Bad
Lippspringe, W. Germany
M. Kohlhardt
Physiologisches Institut, Universitat Freiburg, 7800 Freiburg,
W.Germany
D.Krikler
Cardiovascular Division, Royal Postgraduate Medical School,
Hammersmith Hospital, London W12 OH2, Great Britain
P. Larochelle
Institut de Recherches Cliniques de Montreal, 110 avenue des
Pins ouest, Montreal, QC, H2W lR7, Canada
l.-F. Leclercq
H6pital Lariboisiere, 2 rue Ambroise-Pare, 75010 Paris, France
L.Ledain
H6pital Cardiologique, 208 avenue de Magellan, 33604 Pessac,
France
F.Lemire
Institut de Recherches Cliniques de Montreal, 110 avenue des
Pins ouest, Montreal, QC, H2W 1R7, Canada
H.Lietz
Knoll AG, Knollstr. 50, 6700 Ludwigshafen, W. Germany
Lin lui-Chin
Beijing Friendship Hospital, Beijing, Peoples Rebublic of China
Li Qing-lang
Beijing Friendship Hospital, Beijing, Peoples Republic of China
Liu Pei-Tsun
Beijing Friendship Hospital, Beijing, Peoples Republic of China
B. Liideritz
Medizinische Klinik I der Universitat Miinchen, Klinikum Gross
hadem, Marchioninistr. 15, 8000 Miinchen 70, W. Germany