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Long-term effects of theophylline in atrial fibrillation with a slow ventricular response

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      Abstract

      In 17 patients (aged 78 ± 9 years) with symptomatic atrial fibrillation and a slow ventricular response not related to drugs, a resting electrocardiogram and 24-hour Hotter recording were obtained before and 5 to 6 days after administration of slow-release theophylline (700 mg/day), and successively every 3 months during the long-term phase. Fourteen patients had organic heart disease, and 13 complained of syncope or presyncope, and 4 of asthenia and easy fatigability. At the steady-state evaluation, theophylline significantly increased resting heart rate (HR) by 42%, mean 24-hour HR by 31% and minimal 24-hour HR by 34%. Cardiac pauses >2,500 ms disappeared or markedly decreased. The daily number of wide QRS complexes increased. Serum theophylline level was 13 ± 5 ng/ml. During the follow-up period (20 ± 18 months), the mean daily theophylline dosage was 450 mg and the mean serum theophylline level 9 ng/ml. Seven patients died: 1 because of heart failure, and 6 because of noncardiac death. One patient complained of a syncopal episode during 1 visit. The drug markedly reduced asthenia and easy fatigability. During the longterm phase, HR increased spontaneously in 3 patients, and the treatment was interrupted. In 2 patients, theophylline had to be discontinued because of gastric intolerance. During long-term therapy, HR was similar to that observed at the steady-state evaluation, despite the reduction in daily dosage. The data suggest that theophylline is an effective therapy in most patients with symptomatic atrial fibrillation and a slow ventricular response.
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      References

        • Benditt DG
        • Benson Jr, W
        • Kreitt J
        • Dunnigan A
        • Pritzker MR
        • Crouse L
        • Scheiman MM
        Electrophysiologic effects of theophylline in young patients with recurrent symptomatic bradyarrhythmias.
        Am J Cardiol. 1983; 52: 1223-1229
        • Alboni P
        • Ratto B
        • Cappato R
        • Rossi P
        • Gatto E
        • Antonioli GE
        Clinical effects of oral theophylline in sick sinus syndrome.
        Am Heart J. 1991; 122: 1361-1367
        • Saito D
        • Matsubara K
        • Yamanari H
        • Obayashi N
        • Uchida S
        • Maekawa K
        • Sato T
        • Mizuo K
        • Kobayashi H
        • Haraoka S
        Effects of oral theophylline on sick sinus syndrome.
        J Am Coll Cardiol. 1993; 21: 1199-1204
        • Alboni P
        • Ratto B
        • Scarfo S
        • Rossi P
        • Cappato R
        • Paparella N
        Dromotropic effects of oral theophylline in patients with atrial fibrillation and a slow ventricular response.
        Eur Heart J. 1991; 12: 630-634
        • Eiriksson CE
        • Writer SL
        • Vestal RE
        Theophylline-induced alterations in cardiac electrophysiology in patients with chronic obstructive pulmonary disease.
        Am Rev Respir Dis. 1987; 135: 322-326
        • Butcher RW
        • Sutherland EW
        Adenosine 3′,5′-monophosphate in biological materials.
        J Biol Chem. 1961; 237: 1244-1250
        • Polson JB
        • Krzanowski JJ
        • Goldman AL
        • Szentivanyi A
        Inhibition of human pulmonary phosphodiesterase activity by therapeutic levels of theophylline.
        Clin Exp Pharmacol Physiol. 1978; 5: 535-539
        • Higbee MD
        • Kumar M
        • Galant SP
        Stimulation of endogenous catecholamine release by theophylline: a proposed additional mechanism of action for theophylline.
        J Allergy Clin Immunol. 1982; 70: 377-382
        • Honey RM
        • DiMarco JP
        • Belardinelli L
        Dromotropic effects of adenosine and adenosine antagonists in the treatment of cardiac arrhythmias involving the atrioventricular node.
        Circulation. 1984; 69: 1195-1197
        • Sollevi A
        • Ostergren J
        • Fagrell B
        • Hjemdahl P
        Theophylline antagonizes cardiovascular responses to dipyridamole in man without affecting increases in plasma adenosine.
        Acta Physiol Scand. 1984; 121: 165-171
        • Whyte KF
        • Addis GJ
        • Whitesmith R
        • Reid JL
        Failure of chronic theophylline therapy to alter circulating catecholamines.
        Eur J Respir Dis. 1987; 70: 221-228
        • Alboni P
        • Rossi P
        • Ratto B
        • Pedroni P
        • Gatto E
        • Antonioli GE
        Electrophysiologic effecls of oral theophylline in sinus bradycardia.
        Am J Cardiol. 1990; 65: 1037-1039
        • Dattilo GL
        • Eiriksson Jr, CE
        • Vestal RE
        Increased ventricular response rate during exercise in patients with atrial fibrillation treated with theophylline.
        Arch Intern Med. 1992; 152: 797-803
        • Rall TW
        The melhylxanthines.
        in: Gilman AG Goodman LS The Pharmacological Basis of the Therapeutics. 7th ed. McMillan, New York1985: 589-603