COMPLETE SINUS ARREST DURING DILTIAZEM THERAPY - CLINICAL CORRELATES AND EFFICACY OF INTRAVENOUS CALCIUM

The occurrence of severe sinus node dysfunction in 10 patients (three males and seven females; mean age 78·5±3·4, range 57-92 years) receiving oral diltiazem therapy (mean 190±20 mgl24 h, range 90-300) is described Six of them were concomitantly taking amiodarone andlor beta-blocking agents. On admission, seven patients exhibited systemic hypotension and nine complained of asthenia and/or dizziness or drowsiness. ECG findings showed in all a persistent sinus arrest with atrial, junctional or ventricular escape, leading to a mean heart rate of 40·2±3 beats. min-1 (range 257ndash;56). All patients had chronic renal failure on biological tests, with a mean endogenou.s creatinine clearance of 25±3 ml. min-1 (range 12-36). Intravenous calcium hydrochloride (mean 1·4±0·2 g, range 1-2), given in nine patients, rapidly restored stable sinus activity in seven. We suggest that diltiazem should be given cautiously to ageing patients with chronic renalfailure, and confirm the efficacy of intravenous calcium in reversing calcium channel blocker toxicity on sinus node. © 1994 The European Society of Cardiology.