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Comparison of ventricular escape rates after administration of atropine, dopamine, and aminophylline in stable patients with chronic, high-grade atrioventricular block: an open-label, crossover pilot study in Turkish patients

Current Therapeutic Research
Publication Date
DOI: 10.1016/s0011-393x(02)80036-4
  • Atrioventricular Block
  • Dopamine
  • Aminophylline
  • Atropine
  • Medicine
  • Pharmacology


Abstract Background: Bradyasystolic episodes are frequently observed in patients who present with presyncope, syncope, or sudden cardiac death to emergency departments. Current therapeutic modalities in treating patients with bradyasystolic episodes include pharmacotherapeutic agents (eg, atropine, epinephrine, and dopamine) and cardiac pacing. Objective: The aim of this open-label, crossover, prospective, sequential, pilot study was to compare the effects of 3 agents—atropine, dopamine, and aminophylline—on ventricular escape rate in Turkish patients. Methods: Eligible patients were stable and had chronic, symptomatic, second-degree 2:1 or third-degree atrioventricular (AV) block with a narrow complex escape rhythm. Patients who were receiving a pharmacotherapeutic regimen or who presented with a wide QRS complex escape rhythm, severely disturbed hemodynamic status, an electrolyte disturbance, previous heart surgery, myocarditis, or a reversible underlying cause (eg, acute ischemia) were excluded from the study. Study drugs were given in the same sequential order to all patients, without a washout period, until the ventricular escape rate returned to the initial level. Atropine (1 mg), dopamine (7.5 and 15 μg/kg/min), and aminophylline (240 mg, twice) were sequentially given to each patient. Results: Twelve consecutive patients (5 women, 7 men; mean age, 69 ± 14 years) were enrolled. Compared with the baseline rate, a significantly improved ventricular escape rate was found after the beta-mimetic dose of dopamine (44 ± 6 beats/min vs 49 ± 10 beats/min; P = 0.005). Improvement in ventricular escape rate was also shown after the alpha-mimetic dose of dopamine, but it was not as dramatic as with the beta-mimetic dose (49 ± 10 beats/min vs 52 ± 13 beats/min; P = NS). Compared with the baseline rate, the ventricular escape rate was significantly increased after the second dose of aminophylline (45 ± 10 beats/min vs 50 ± 8 beats/min; P = 0.04). Conclusions: This study revealed that, in this patient population, significant acceleration of the ventricular escape rate was found after both the beta-mimetic dose of dopamine and high-dose aminophylline. This study may have been limited by its small sample size and short duration. Additional studies with larger sample sizes and of longer duration are needed to prove that dopamine and high-dose aminophylline can be used as therapy for patients with high-grade AV block and a slow escape rate.

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