TY - JOUR
T1 - Electrophysiologic effects of milrinone in patients with congestive heart failure
AU - Goldstein, Richard A.
AU - Geraci, Stephen A.
AU - Gray, Elayne L.
AU - Rinkenberger, Robert L.
AU - Dougherty, Anne Hamilton
AU - Naccarelli, Gerald V.
N1 - Funding Information:
From the Division of Cardiology, University of Texas Medical School at Houston, Houston, Texas. This study was supported in part by Sterling-Winthrop Research Institute, Renesselaer, New York. Dr. Goldstein is recipient of New Investigator Award IRZ3HL28216-03 from the National Institutes of Health, Bethesda, Maryland. Manuscript received July 15,1985; revised manuscript received September 5,1985, accepted September 6,1985.
PY - 1986/5/3
Y1 - 1986/5/3
N2 - The electrophysiologic effects of milrinone, a new inotropic agent, have not been characterized in humans. Accordingly, 10 patients with class III or IV congestive heart failure underwent hemodynamic and electrophysiologic testing before and during an infusion of milrinone (0.5 μg/kg/min). Cardiac index increased from a mean of 1.65 ± 0.51 to 2.19 ± 0.68 liters/min/m2 (p < 0.03) and pulmonary artery capillary pressure decreased from 30 ± 9 to 22 ± 9 mm Hg (p < 0.01), without a significant change in systemic arterial pressure. Holter monitoring was performed for 48 hours at baseline and during infusion of milrinone. Frequency of ventricular premature complexes and ventricular couplets did not change significantly. Frequency of ventricular tachycardia (VT) increased significantly, although no patients would be classified as having a proarrhythmic effect based on a clinical model. PR, QRS, QTc, heart rate, AH, HV, atrial, atrioventricular and ventricular effective and functional refractory periods were not affected. Milrinone decreased 1:1 atrioventricular maximal conduction from 399 ± 133 to 374 ± 111 ms (p < 0.01); ventriculoatrial conduction was not significantly affected. During programmed right ventricular stimulation, 5 patients had inducible VT at baseline (3 sustained, 2 non-sustained), whereas after drug administration, none had it (p < 0.05). Thus, intravenous milrinone is an effective inotropic drug that also enhances atrioventricular conduction and may decrease the incidence of inducible VT in patients with congestive heart failure.
AB - The electrophysiologic effects of milrinone, a new inotropic agent, have not been characterized in humans. Accordingly, 10 patients with class III or IV congestive heart failure underwent hemodynamic and electrophysiologic testing before and during an infusion of milrinone (0.5 μg/kg/min). Cardiac index increased from a mean of 1.65 ± 0.51 to 2.19 ± 0.68 liters/min/m2 (p < 0.03) and pulmonary artery capillary pressure decreased from 30 ± 9 to 22 ± 9 mm Hg (p < 0.01), without a significant change in systemic arterial pressure. Holter monitoring was performed for 48 hours at baseline and during infusion of milrinone. Frequency of ventricular premature complexes and ventricular couplets did not change significantly. Frequency of ventricular tachycardia (VT) increased significantly, although no patients would be classified as having a proarrhythmic effect based on a clinical model. PR, QRS, QTc, heart rate, AH, HV, atrial, atrioventricular and ventricular effective and functional refractory periods were not affected. Milrinone decreased 1:1 atrioventricular maximal conduction from 399 ± 133 to 374 ± 111 ms (p < 0.01); ventriculoatrial conduction was not significantly affected. During programmed right ventricular stimulation, 5 patients had inducible VT at baseline (3 sustained, 2 non-sustained), whereas after drug administration, none had it (p < 0.05). Thus, intravenous milrinone is an effective inotropic drug that also enhances atrioventricular conduction and may decrease the incidence of inducible VT in patients with congestive heart failure.
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U2 - 10.1016/0002-9149(86)90847-7
DO - 10.1016/0002-9149(86)90847-7
M3 - Article
C2 - 3953448
AN - SCOPUS:0022481941
SN - 0002-9149
VL - 57
SP - 624
EP - 628
JO - The American journal of cardiology
JF - The American journal of cardiology
IS - 8
ER -