Supraventricular tachycardia: reentrant: diltiazem effectively terminated the arrhythmia.

Clinical bottom line (level 1b)

  1. Patients with recurrent symptomatic supraventricular tachycardias due to a reentrant pathway, who received diltiazem compared with placebo, following electrophysiologic induction of the arrhythmia, were more likely to revert to sinus rhythm (NNT = 2 at 15 minutes) .
Huycke et al: Journal of the American College of Cardiology 1989; 13 (3): 538-544
Expires October 2004

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: 8 acute hospitals, USA

54 patients (aged 17 to 89; mean 41, 62% male) with recurrent symptomatic supraventricular tachycardia (confirmed on electrophysiological testing to be a reproducibly induced, haemodynamically well-tolerated supraventricular tachycardia lasting 15 minutes at a heart rate > 120 beats/min). 63% had Wolff-Parkinson-White syndrome.

Excluded if
  • taken antiarrhythmic drugs within 5 half-lives
  • hepatic or renal disease


    • Control Group: (n = 26, 26 analysed): placebo
    Experimental Group: (n = 28, 28 analysed): diltiazem 0.25 mg/kg iv bolus, followed by 0.35 mg/kg if arrhythmia failed to terminate

    100% followed for 15 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no termination of arrhythmia 15 minutes 21
    (80.8%)    		 4
    (14.3%)    		 82%
    (55% to 93%)    		 66.5%
    (46.6% to 86.4%)    		 2
    (1 to 2)

    Comments

    1. Patients who failed to convert after two bolus injections were given iv diltiazem. Overall 3/48 (6%) of patients had adverse effects (atrial flutter, prolonged correction of sinus node recovery, fatigue).

    Citation

    1. Huycke EC, Sung RJ, Dias VC, et al: Intravenous diltiazem for termination of reentrant supraventricular tachycardia: A placebo-controlled, randomised, double-blind, multicenter study. Journal of the American College of Cardiology 1989; 13 (3): 538-544
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient reentrant supraventricular tachycardia
    Intervention or Exposure diltiazem
    Comparison placebo
    Outcome termination of arrhythmia