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European Heart Journal 1992 13(2):261-268;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Effects of a combination of disopyramide and mexiletine on the anterograde accessory pathway conduction in patients with Wolff-Parkinson-White Syndrome

W. SHIMIZU, T. OHE, T. KURITA, H. TAKAKI, N. AIHARA, S. KAMAKURA, M. MATSUHISA and K. SHIMOMURA

Cardiology Division of Medicine. National Cardiovascular Center Suita, Osaka, Japan

Received 15 October 1990; revised 1 March 1991; .

Correspondence: wataru Shimizu, M.D. Cardiology Division of Medicine. National Cardiovascular Center. 5-7-1 Fujishiro-dai, Suita, Osaka, Japan, 565

Abstract

In order to evaluate the electrophysiological effects of the combined administration of disopyramide and mexiletine on anterograde accessory pathway conduction, we studied 11 patients with Wolff-Parkinson- White (WPW) syndrome. Disopyramide was first infused intravenously at 1 mg kg–1for 5 min followed by a continuous infusion at 0.025 mg kg–1 min–1. After the infusion rate of disopyramide was decreased to 0.004 mg kg–1 mm–1 to maintain a lower serum concentration, mexiletine was infused at 2mg kg–1 for 5 min followed by a continuous infusion at 0.008mg kg–1 min–1 (protocol 1). The shortest atrial paced cycle length with 1:1 anterograde accessory pathway conduction (shortest CL with 1:1) and the anterograde effective refractory period of the accessory pathway (ERP) were measured: (1) before drug administration, (2) after disopyramide was given alone, and (3) after disopyramide and mexiletine were combined at lower concentrations. The same protocol was repeated with the order of drug administration reversed (mexiletine followed by disopyramide) in all patients (protocol 2). Both disopyramide and mexiletine lengthened the shortest CL with 1:1 and the ERP to the same degree. The combination of disopyramide and mexiletine at lower concentrations further lengthened the shortest CL with 1:1. It was longer than with disopyramide (protocol 1) or mexiletine (protocol 2) alone [protocol 1. 412 ± 169 ms (combination) vs 356 ± 117 ms (disopyramide); P <0.05, protocol 2: 409 ± 166 ms (combination) vs 355 . 119 ms (mexiletine); P <0.01]. The combination lengthened the ERP more than did mexiletine alone [332 ± 73 ms (combination) vs 299 ± 42 ms (mexiletine): p <0.05]. Moreover, it lengthened the shortest and the mean RR interval during atrial fibrillation more than disopyramide or mexiletine did alone in alifour patients in whom atrial fibrillation was induced. We conclude that a combination of disopyramide and mexiletine has at least additive effects on anterograde accessory pathway conduction in patients with WPW syndrome.

Key Words: Disopyramide • mexiletine • accessory pathway • Wolff-Parkinson-White syndrome


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