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Theophylline for the Treatment of Atrioventricular Block after Myocardial Infarction

Barry D. Bertolet, MD; Elzbieta B. McMurtrie, MD; James A. Hill, MD; and Luiz Belardinelli, MD
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From the University of Florida Health Sciences Center and Gainesville Veterans Affairs Medical Center, Gainesville, Florida. Requests for Reprints: Barry D. Bertolet, MD, Box 100-277, JHMHC, University of Florida, Gainesville, FL 32610. Current Author Addresses: Drs. Bertolet, McMurtrie, Hill, and Belardinelli: Box 100-277, JHMHC, University of Florida, Gainesville, FL 32610.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(7):509-511. doi:10.7326/0003-4819-123-7-199510010-00006
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Objective: To show that second- or third-degree atrioventricular block occurring as an early complication of acute inferior myocardial infarction is mediated by adenosine.

Setting: Cardiac care unit.

Design: Uncontrolled, observational, hypothesis-driven study.

Patients: Patients who developed clinically significant atrioventricular nodal blockade within 4 hours of admission for acute inferior myocardial infarction.

Intervention: Theophylline, 100 mg/min intravenously to a maximum of 250 mg.

Measurements: Continuous multilead electrocardiographic monitoring before and after administration of theophylline.

Results: During a 6-month period, eight men who had had acute inferior myocardial infarction developed clinically significant atrioventricular block. Three had third-degree block, and five had high-grade second-degree block. In all patients, 1:1 atrioventricular nodal conduction was restored and normal sinus rhythm reappeared within 3 minutes of the administration of theophylline. All patients remained free of arrhythmia for at least 24 hours.

Conclusions: Adenosine produced by the ischemic myocardium may induce atrioventricular nodal block. In our patients, atrioventricular nodal block was resistant to conventional therapy such as atropine, but it responded to the adenosine antagonist theophylline.


Grahic Jump Location
Figure 1.
Electrocardiographic recordings from leads II and aVF. Top.Bottom.

New-onset third-degree heart block (p waves are marked by arrows) that began 45 minutes after the patient was hospitalized for an acute inferior myocardial infarction. The patient had accompanying dizziness and on physical examination had cool, clammy skin and a systolic blood pressure of 68 mm Hg. After the administration of theophylline, 150 mg, an immediate conversion to normal sinus rhythm with 1:1 atrioventricular conduction occurred. The patient's systolic blood pressure increased to 110 mm Hg, and all symptoms abated. The normal sinus rhythm persisted for more than 36 hours of observation.

Grahic Jump Location




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