Calcium channel blockers as first line treatment for broad complex tachycardia with right bundle branch block: ingenuity or folly?

• Published in: Resuscitation 2002-02, Vol.52 (2), p.175-182
• Main Authors: Wang, Jenn Chyuan, Lim, Swee Han, Teo, Wee Siong, Anantharaman, V
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bundle-Branch Block - complications; Calcium Channel Blockers - administration & dosage; Calcium Channel Blockers - therapeutic use; Diltiazem; Diltiazem - administration & dosage; Diltiazem - therapeutic use; Electrocardiography; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Treatment; Female; Humans; Idiopathic left ventricular tachycardia; Infusions, Intravenous; Intensive care medicine; Lignocaine; Male; Medical sciences; Resuscitation; Retrospective Studies; Tachycardia, Ventricular - complications; Tachycardia, Ventricular - drug therapy; Verapamil; Verapamil - administration & dosage; Verapamil - therapeutic use
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/S0300-9572(01)00458-0

Objective: To study the response of regular broad-complex tachycardia (BCT) demonstrating right bundle branch block (RBBB) to treatment in the Emergency department (ED). Methods: Retrospective chart review of management of patients with BCT, RBBB without a history of ischaemic heart disease. A diagnosis of ventricular tachycardia (VT) was made if the ECG showed features such as atrioventricular dissociation, capture or fusion beats or if VT was demonstrated during electrophysiological studies (EPS). Results: A total of 25 patients were eligible. Nineteen patients were given intravenous (IV) calcium channel blockers (either verapamil or diltiazem), as first line treatment. Of these, 18 converted to sinus rhythm and the other one patient subsequently converted with amiodarone. The remaining six patients were given IV adenosine ( n=3), lignocaine ( n=2) or amiodarone ( n=1) as first line treatment but none of them were converted. Of these, four of them converted with IV calcium channel blockers eventually. Of the other two patients, who were both given lignocaine initially, one deteriorated haemodynamically with the use of verapamil and required synchronised cardioversion to convert. The other patient did not respond to amiodarone and synchronised cardioversion but was subsequently converted with verapamil. The difference between the success rate of calcium channel blockers and other anti-arrhythmics is statistically significant ( P