The effects of propranolol on induction of A-V nodal reentrant paroxysmal tachycardia

Twelve patients with paroxysmal supraventricular tachycardia (PSVT) were studied before and after intravenous administration of 0.1 mg/kg propranolol. Echo zones for inducing atrioventricular (AV) nodal reentry were determined using His bundle recording and the atrial extrastimulus technique. After propranolol the echo zone was abolished in 2 patients, decreased in 1, unchanged in 5 and increased in 2. In 2 patients echo zones appeared only after propranolol. Nine patients had episodes of sustained PSVT prior to propranolol. Following propranolol PSVT persisted in only 5. In these 5 patients propranolol slowed the rate of PSVT. The data were analyzed by plotting A₁ vs A₂ and H₁ vs H₂ interval curves. On the basis of these curves the patients were separated into those with 'dual pathways' and those with 'reflection'. The effects of propranolol on both conduction patterns are discussed. The actions of propranolol in PSVT patients were variable. Potentially beneficial effects included slowing of induced PSVT, loss of the ability to sustain PSVT, and decrease or total elimination of echo zones. Potentially deleterious effects included potentiation of the echo phenomenon with either increase or development of echo zones.