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  • 1
    ISSN: 1432-1041
    Keywords: Atropine ; M2-cholinoceptors ; effect kinetics ; radioreceptor assay ; healthy volunteers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract The effects of an oral dose of atropine (0.03 mg/kg body weight) and an IM (0.02 mg/kg) dose on the heart rate and salivary flow in seven healthy adult volunteers were compared to see whether the oral dose was sufficient to inhibit vagal reflexes of the heart. Atropine concentrations in plasma were determined by an M2-selective radioreceptor assay, and the in vitro occupancy of porcine cardiac M2-cholinoceptors was measured in parallel. In ligand-binding studies, atropine has been shown to have a comparable affinity for human and porcine cardiac M2-cholinoceptors (Ki 4.0 and 5.9, respectively). Slight changes in heart rate after oral administration were not significant. After IM administration, however, the heart rate increased significantly, by a maximum of 22 beats·min−1 after 45 min. The slight increase in heart rate after the oral dose corresponded to a receptor occupancy in vitro near the lower limit of detection, whereas the significant increase in heart rate after the IM dose corresponded to a receptor occupancy of up to 47%. The maximum reduction in salivary flow was similar after the oral and IM doses (84.3 and 87.5%, respectively). The almost complete inhibition of salivary flow could be explained by the lower vagal tone in the salivary glands compared with to the heart. The difference in the effect on heart rate was probably due to lower absorption of the oral dose. Thus, an oral dose greater than 0.03 mg atropine/kilogram body weight is required to compensate for low gastrointestinal absorption and to overcome the high vagal tone of the heart.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1435-1285
    Keywords: Key words Dual AV nodal conduction – double ventricular responses – slow pathway radiofrequency ablation ; Schlüsselwörter Duale AV-Knoten Leitungsphysiologie – doppelte Ventrikelerregung – Hochfrequenz-Katheterablation der langsamen Leitungsbahn
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Unterschiedliche elektrokardiographische Manifestationen einer dualen AV-Knoten-Leitungsphysiologie sind beschrieben. Ein besonders selten auftretender Subtyp stellt hier die doppelte ventrikuläre Erregung dar. Wir berichten über eine 53-jährige Patientin mit über sieben Jahren bestehenden typischen paroxysmalen regelmäßigen Tachykardien. In den vergangenen sechs Monaten kam es zu einer Änderung der vorbestehenden Symptomatologie der Herzrhythmusstörungen mit einem Wechsel zu länger anhaltenden und irregulär empfundenen Rhythmusstörungen. Medikamentöse Behandlungsversuche mit Antiarrhythmika der Klasse I waren nicht erfolgreich. Ein Therapieversuch mit Beta-Blockern verstärkte die subjektiven Beschwerden. Nach erneuter Befundung des EKG der Patientin wurde vom zuweisenden Krankenhaus die Diagnose einer dualen AV-nodalen Leitungsphysiologie mit doppelter Ventrikelerregung gestellt und die Patientin unserer Klinik zur invasiven elektrophysiologischen Untersuchung und zur Katheterablation des langsamen Leitungsweges des dualen AV-Knotens zugewiesen. Die invasive elektrophysiologische Untersuchung bestätigte die Diagnose eines dualen AV-Knotens mit doppelter Ventrikelerregung. Die Hochfrequenz-Katheterablation der langsamen Leitungsbahn erreichte die vollständige Unterbrechung der doppelten Ventrikelerregung. Das erfolgreiche Ablationsergebnis konnte durch Langzeit-EKG-Registrierung und Belastungsergometrie weiterführend bestätigt werden. Während einer dreimonatigen Nachbeobachtung blieb die Patientin vollständig asymptomatisch und es kam zu keiner Wiedererholung der dualen AV-Knoten Leitungsphysiologie im Oberflächen-EKG.
    Notes: Summary A variety of electrocardiographic manifestations of dual AV nodal physiology have been reported. The specific subtype dual ventricular response is considered as a very rare phenomenon. We present the case of a 53 year old lady who suffered from paroxysmal regular tachycardias for more than seven years. In the last 6 months the symptomatology of the cardiac arrhythmia changed to more persistent und irregular rhythm disturbances. Treatment with class Ia antiarrhythmic drugs and beta-blocking agents failed. The latter even seemed to worsen her very disturbing palpitations. After examination of the ECG recordings, the diagnosis of dual AV nodal physiology with double ventricular response was made – the lady was referred to our institution for electrophysiological testing and radiofrequency catheter ablation of the slow pathway. An invasive electrophysiological study reconfirmed the diagnosis of a dual AV nodal conduction pattern with irregular double ventricular response. The radiofrequency catheter ablation of the the slow pathway achieved a complete cessation of the double ventricular response. This satisfactory outcome was confirmed by analysis of a postinterventional 24hour holter recording and an exercise stress test. During a follow-up period of three months, the patient remained free of symptoms and there was no recurrence of dual AV nodal conduction physiology in the surface ECG.
    Type of Medium: Electronic Resource
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