Sequential bilateral bundle branch block during dofetilide, a new class III antiarrhythmic agent, in a patient with atrial fibrillation
Abstract
INTRODUCTION: The mechanism of wide QRS complex tachycardias during dofetilide infusion was studied in a patient with atrial fibrillation. METHODS AND RESULTS: Endocardial recordings from the intraventricular conduction system showed that dofetilide caused "classic" aberrant conduction (Ashman phenomenon, typical QRS morphology) at high prematurity ratios (preceding interval = 1.78 x coupling interval--290), thus mimicking ventricular ectopy. In addition, there was frequent sequential bilateral bundle branch block, caused by a significant difference in preceding bundle-to-bundle intervals (mean difference +/- 1 SD: 74 +/- 26 msec). CONCLUSION: The present findings may prove helpful in the clinical assessment of wide QRS complex rhythms after dofetilide and possibly other "pure" Class III antiarrhythmics.
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Class Ic and Ia drugs and class III drugs can both result in atypical BBB morphologies during SVT that mimics VT.
“They can both result in atypical BBB morphologies during SVT that mimics VT.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [54]
Class Ic and Ia drugs cause use-dependent slowing of conduction, and class III drugs prolong refractoriness at His-Purkinje tissue more than in the ventricular myocardium.
“Class Ic and Ia drugs cause use-dependent slowing of conduction, and class III drugs prolong refractoriness at His-Purkinje tissue more than in the ventricular myocardium.54,55”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [54]
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Self-citation
- Authors
- CRIJNS, H. J. G. M., KINGMA, J. H., GOSSELINK, A. T. M., DALRYMPLE, H. W., De LANGEN, C. D. J., & LIE, K.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- CRIJNS, HARRY J.G.M.
- ORCID
- CRIJNS, HARRY J.G.M.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 1993-08
- Volume
- 4
- Issue
- 4
- Pages
- 459-466
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2151817941
- Cited by
- 18
- References
- 23
- Citations by year
- 2021: 1 · 2020: 1 · 2016: 1 · 2015: 1
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- dofetilide, class III antiarrhythmic agents, atrial fibrillation, wide QRS tachycardia
- MeSH terms
- Adult, Anti-Arrhythmia Agents, Atrial Fibrillation, Bundle-Branch Block, Electrocardiography, Heart Conduction System, Humans, Male, Phenethylamines, Sulfonamides
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