LETTER
Theophylline and Atrioventricular Block
Richard L. Weiss, MD
1 September 1996 | Volume 125 Issue 5 | Page 421
TO THE EDITOR:
I read with great interest the recent report by Bertolet and colleagues [1] on theophylline for the treatment of atrioventricular block after myocardial infarction. The article was innovative but left many questions unanswered. In the Methods section, the authors discussed administering theophylline as a slow intravenous injection at a rate of 100 mg/min until a maximum of 250 mg was given. Clearly, in all eight patients, the medication did work to convert bradyarrhythmia. Three patients each received 250 mg of theophylline, but the time to conversion was 1 minute, 3 minutes, 1 minute, respectively.
What were the criteria for stopping the infusion? Was it stopped when normal sinus rhythm resumed, or was the protocol changed to give a maximum of 250 mg empirically over 2.5 minutes or 3 minutes? No data were provided on the long-term outcome of these patients, such as how many patients survived to hospital discharge and how many subsequently had electrophysiologic studies or required permanent cardiac pacing. Did arrhythmia recur in any of these patients, and did any patient require further treatment with theophylline?
Until outcome data are provided, it would be difficult to conclude that the use of theophylline obviated the need for temporary cardiac pacing.
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Author and Article Information
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Robert Wood Johnson Medical School, Camden, NJ 08103
1. Bertolet BD, McMurtrie EB, Hill JA, Belardinelli L. Theophylline for the treatment of atrioventricular block after myocardial infarction. Ann Intern Med. 1995; 123:509-11.
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