Electrophysiologic study on atrioventricular nodal reetrant tachycardia with special reference to recent controversies.
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Electrocardiographic and electrophysiologic studies were performed in 21 patients with atrioventricular (A-V) nodal reentrant tachycardia (AVNRT). Patients were classified into three types according to the patterns during the tachycardia, i.e., (1) type I; an atrial echo (Ae) occurred simultaneously with a ventricular electrogram (VE) (14 patients), (2) type II; an Ae occurred in front of the next VE (four patients) and (3) type III; an Ae followed immediately after the preceding VE (three patients). All patients with type I AVNRT showed discontinuous A-V and continuous ventriculoatrial (V-A) conduction curves. "Enhanced V-A conduction" (1:1 V-A conduction at the ventricular paced rate of 200 beats/min) was demonstrated in five of the 14 and after verapamil in two of the five patients. In type II AVNRT the tachycardia was initiated with a minimal amount of A-V nodal conduction delay and second degree A-V or V-A block was observed in all four patients. V-A conduction was poor in these patients. In type III AVNRT A-V conduction curves were discontinuous and retrograde study revealed the presence of retrograde dual A-V nodal pathways. In conclusion, A-V and V-A conduction in patients with AVNRT were variable and this variability seemed to be responsible for different patterns of AVNRT. (+info)
Effects on atrio-ventricular conduction of propranolol, pindolol and carteolol in the dog heart in situ as assessed by automated devices.
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In open-chest dogs the heart rate was controlled at 150 beats/min and drugs were given intravenously. Propranolol (30 microgram/kg--1 mg/kg) prolonged the atrioventricular (A-V) conduction time and functional refractory period of the A-V conduction system (FRP) by blockade of the existing tone of the sympathetic nerves to the heart. The prolongation of the two parameters by the non-specific depressant action of propranolol was evident only at 3 mg/kg. Propranolol (3--30 microgram/kg) shortened the A-V conduction time in the heart deprived of the vagal and sympathetic tone, suggesting some sort of sympathomimetic effect. Pindolol in a wide range of doses (0.3--300 microgram/kg) exerted virtually no effect on the A-V conduction time and FRP, and its non-specific depressant action was apparent only at 3 mg/kg. Carteolol slightly prolonged the A-V conduction time and FRP only in low doses (1--10 microgram/kg), and in high doses (30 microgram/kg--1 mg/kg) it shortened the two parameters, reflecting its predominant sympathomimetic action. (+info)
Topical beta-blockade with intrinsic sympathomimetic activity offers no advantage for the respiratory and cardiovascular function of elderly people.
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Topical therapy with beta-antagonists, such as timolol, may cause unrecognized impairment of respiratory and cardiovascular function in elderly people. Beta-antagonists with intrinsic sympathomimetic or cardioselective properties, such as carteolol or betaxolol, may cause less impairment. In a randomized, double-masked study of glaucoma patients, over 60 years of age, without history of bronchospasm and who were using timolol (0.5%), 60 patients were allocated to betaxolol (0.5%) or carteolol (2%) or continued timolol (0.5%) treatment. Spirometry, pulse and blood pressure were measured on enrollment and after 4 weeks. In the timolol and carteolol groups there were no significant changes in mean spirometric values. Changing to betaxolol improved mean peak flow (PF) by 9.1%, from 310 to 3411/min (p < 0.05) and forced expiratory volume in 1 second (FEV1) by 9.4%, from 1.74 to 1.861 (p < 0.05). Differences in the changes in PF and FEV1 between betaxolol and timolol as well as betaxolol and carteolol groups were statistically significant (p < 0.05). Twenty-one per cent of those allocated to betaxolol showed clinically significant improvement in FEV1. There was no change in pulse or blood pressure when carteolol was substituted for timolol but an increase of 10 beats per minute (p < 0.05) in mean resting pulse in the betaxolol group. Therapy with cardioselective beta-blockade may offer significant advantages in respiratory function for elderly people with glaucoma over non-selective drugs, even if they have sympathomimetic activity. (+info)
Short-term comparative study of topical 2% carteolol with and without benzalkonium chloride in healthy volunteers.
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AIM: A crossover, randomised double blind study was undertaken in 30 healthy volunteers, in order to compare the tolerance of 2% carteolol with and without preservative in short term use. METHODS: Complete ophthalmic examinations were performed before and 30, 60, and 180 minutes after instillation of one drop of the solution, and after 3 days of preservative treatment. After a 5 day washout, the same examinations were done with the second drug. RESULTS: Results showed good general tolerance for both formulations. No significant difference in subjective tolerance, corneal aesthesiometry, punctuate keratitis, Schirmer's test, intraocular pressure (IOP) decrease (about 25% in the two groups at 3 hours, 10% after 3 days of treatment), resting cardiac frequency, or blood pressure was observed. However, break up time was significantly reduced from baseline by preserved carteolol both at 3 hours (10.40 (5.9) seconds to 6.15 (3.9) seconds, p = 0.001) and after 3 days (7.72 (5.5) seconds, p = 0.04). Preservative free carteolol did not significantly change the break up time (baseline 9.08 (5.7) seconds; 3 hours = 7.88 (5.5) seconds, not significant; day 3 = 8.35 (5.8), non-significant). CONCLUSIONS: These results confirm that carteolol is well tolerated, either with or without preservative. The preservative free group showed better stability of the tear film, without loss of effect on IOP. This difference, although mild in the healthy young subjects in the present study could be much more relevant in those patients treated long term, older patients, and/or those suffering from ocular surface disorders. In such instances, preservative free drugs could be of potential benefit to protect the lacrimal fluid integrity and corneoconjunctival surface. (+info)