Effect of amiodarone in the Wolff-Parkinson-White syndrome. A clinical and electrophysiological study

Six patients with Wolff-Parkinson-White (WPW) syndrome were given long-term treatment with amiodarone. Symptomatic relief was obtained in all. Tolerance to the drug was good. Reversible corneal changes appeared after some weeks' treatment in five patients. No thyroid side-effects were noticed. Prior to treatment, dual atrioventricular (AV) conduction was demonstrated on His bundle electrograms in all six patients. Recordings were made at varied heart rates, using atrial and ventricular pacing. Reciprocating tachycardia was readily provoked by properly timed extra stimuli in all patients. When amiodarone treatment had become clinically effective, a second comparative study was made in four patients after 26--85 days' treatment. Amiodarone reduced heart rate and second degree AV block appeared at a lower atrial pacing rate. It increased the refractory periods of right atrium, AV node, and the accessory pathway in proportion to the duration of treatment. Induction of tachycardia was effectively prevented by the drug. It appears that amiodarone in chronic treatment has a predictable and unique depressant action on cardiac conduction, supporting the opinion that this compound, despite side-effects, has an important role to play in the treatment of refractory arrhythmias in patients with the WPW syndrome.