BACKGROUNDVerapamil-sensitive, idiopathic left ventricular tachycardia (ILVT) with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. Radiofrequency (RF) ablation was applied during ventricular tachycardia (VT) and termination of the VT or abolishing the inducibility of the tachycardia was used as an endpoint for successful RF. In this study, the left posterior fascicular block in surface electrocardiogram (ECG) was used as a new endpoint of ablation to cure ILVT.

METHODSElectrophysiological studies and radiofrequency ablation were performed in 39 consecutive patients [30 men, 9 women; age ranging from 10 to 64 years, mean (29 +/- 16) years] with verapamil-sensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous administration of verapamil in all patients. The target site was the midseptum of LV where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential (LDP) during sinus rhythm in 37 patients and during VT in 2 patients to meet the ablation endpoint: the left posterior fascicular block in the surface ECG.

RESULTSThirty-seven patients with ILVT had been treated by RF ablation during sinus rhythm and two had been treated during VT. All of them met the endpoint of the left posterior fascicular block. Thirty-eight cases were symptom-free without medications during the follow-up period (range from 3 to 95 months, median 17 months). One patient developed a clinical recurrence and the left posterior fascicular block in surface ECG disappeared. The patient received another treatment. The endpoint was met and the procedure was successful.

CONCLUSIONSThe left posterior fascicular block in surface ECG used as an endpoint of RF ablation to treat ILVT is effective. It is important especially in those patients whose VT can not be induced or the inducible condition is unstable. The effective endpoint implied that the left posterior fascicle might be a critical part of the re-entrant circuit.

Adolescent ; Adult ; Catheter Ablation ; methods ; Child ; Diastole ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular ; physiopathology ; surgery ; Verapamil ; therapeutic use

OBJECTIVETo study the anti-arrhythmic efficacy of ginsenoside Re (GSRe) and its protective effects against myocardial injuries in rabbits with isoproterenol-induced triggered ventricular arrhythmia (TVA).

METHODSTVA model was prepared by intravenous injections of isoproterenol at a constant speed of 5 mg/kg/min. When TVA appeared, rabbits were randomly injected with GSRe (5, 10 or 20 mg/kg), verapamil (0.4 mg/kg) or placebo. The duration of maintaining sinus rhythm was observed. Meanwhile, isoproterenol was continued to be injected at a constant speed of 5 mg/kg/min. After 1 hr of isoproterenol injection, the rabbits were sacrificed. Cardiac muscles in the cuspidate position of the left ventricle were sampled for optical microscopy and electron microscopy.

RESULTSGSRe and verapamil treatment restored sinus rhythm. The duration of sinus rhythm was 177.00+/- 5.66 s within 3 minutes in the verapamil treatment group and was 177.83+/- 5.31, 21.00+/- 2.83 and 4.50+/- 1.64 s, respectively, in the 20, 10 and 5 mg/kg GSRe treatment groups. Histopathologic examination demonstrated that GSRe treatment (20 and 10 mg/kg) alleviated myocardial injuries induced by TVA.

CONCLUSIONSGSRe has anti-arrhythmic efficacies and protective effects against myocardial injuries in rabbits with TVA. It may therefore be a possible therapy for TVA.

Animals ; Arrhythmias, Cardiac ; chemically induced ; pathology ; prevention & control ; Ginsenosides ; therapeutic use ; Heart Ventricles ; drug effects ; Isoproterenol ; pharmacology ; Male ; Myocardium ; pathology ; ultrastructure ; Rabbits ; Verapamil ; therapeutic use

OBJECTIVETo assess the efficacy of intracoronary nitroglycerin and verapamil for patients with the coronary slow flow phenomenon (CSFP).

METHODSSixty-four patients with CSFP without stenotic lesions during diagnostic coronary angiography were enrolled and divided into the nitroglycerin group (n = 35) and verapamil group (n = 29), 29 patients with normal coronary flow served as normal control. CSFP was defined when 4 or more heart beats were needed for contrast media to opacify the distal vasculature. Intracoronary injection of 100 - 400 microg nitroglycerin or verapamil through the diagnostic catheter was applied to patients with CSFP to improve coronary flow. The coronary blood flow was evaluated by thrombolysis in myocardial infarction (TIMI) frame count (TFC) method.

RESULTSClinical characteristics were similar among the three groups. The basic TFCs of left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) were 78.3 +/- 19.4, 57.2 +/- 14.6, 56.9 +/- 12.5 in the verapamil group, and were 70.8 +/- 21.7, 55.3 +/- 12.5, 51.1 +/- 15.4 in the nitroglycerin group, respectively, which were significantly higher than those in the normal controls (LAD 29.2 +/- 4.4, LCX 23.1 +/- 3.5 and RCA 19.7 +/- 1.8, respectively). After the administration of drugs, the TFCs of LAD, LCX and RCA were 42.3 +/- 8.9, 36.7 +/- 6.8, 30.3 +/- 5.9 respectively (all P < 0.01 vs. baseline) in the nitroglycerin group and 37.7 +/- 9.3, 31.5 +/- 11.3, 24.6 +/- 4.4 respectively (all P < 0.01 vs. baseline) in the verapamil group. The TFCs after drug administration in both therapy groups were significantly higher than that in normal controls (all P < 0.05). The TFCs decrease in the verapamil group were more significant than that in the nitroglycerin group (all P < 0.05).

CONCLUSIONIntracoronary administration of verapamil could result in more coronary flow improvement in patients with CSFP than nitroglycerin, although the post therapy coronary flow was still slower than normal.

Adult ; Aged ; Coronary Circulation ; Female ; Humans ; Male ; Middle Aged ; Nitroglycerin ; therapeutic use ; No-Reflow Phenomenon ; drug therapy ; Treatment Outcome ; Verapamil ; therapeutic use

OBJECTIVETo investigate the effects of intralesional steroid, interferon alpha-2b or verapamil injection on proliferation, apoptosis and TGF-beta1 expression in keloid and hypertrophic scar in vivo.

METHODS6 patients with keloids and 6 patients with hypertrophic scar were treated with intralesional injection of triamcinolone acetonide (40 mg/ml) or IFN alpha-2b (15 x 10(5) U/ml) or verapamil (2.5 mg/ml). Samples were collected on the 7th day after intralesional injection. Samples of untreated keloid and hypertrophic scar and normal skin were used as control. Expression of PCNA and TGF-beta1 was detected in situ by immunohistochemical staining, and apoptosis was detected in situ by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL).

RESULTS1) Triamcinolone acetonide could prohibit proliferative scars through inhibiting cell proliferation and TGF-beta1 expression, as well as inducing apoptosis. 2) IFN alpha-2b could prohibit proliferative scars through inhibiting cell proliferation and TGF-beta1 expression, but not inducing apoptosis; 3) Verapamil could also prohibit proliferative scars through inhibiting proliferation and TGF-beta1 expression in fibroblasts, as well as inducing apoptosis. While the effect of inducing apoptosis was stronger than that of triamcinolone acetonide, the effect of inhibiting TGF-beta1 expression was weaker than those of triamcinolone acetonide and IFN alpha-2b.

CONCLUSIONSAlthough intraleional injection of steroid, interferon alpha-2b or verapamil were all effective in the treatment of keloid and hypertrophic scar, their mechanisms are not similar.

Adolescent ; Adult ; Apoptosis ; Child ; Cicatrix, Hypertrophic ; drug therapy ; Female ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Proliferating Cell Nuclear Antigen ; metabolism ; Recombinant Proteins ; Steroids ; therapeutic use ; Transforming Growth Factor beta1 ; metabolism ; Verapamil ; therapeutic use ; Young Adult

To determine the effect of verapamil on experimental duodenal ulcer, pathologic assessment and secretory study were performed in the rats with ulcerogenic dose of cysteamine. The cysteamine increased gastric acid secretion and produced double duodenal ulcers at the proximal protion of the duodenum. Intramuscular injection of verapamil, 3 hours later, produced a significant decreased in gastric acid secretion which lasted at least 4 hours (cysteamine vs. cysteamine+ verapamil; 63.5 +/- 18.4 muEq vs. 25.5 +/- 9.0 muEq during the 1st hour after verapamil administration, 83.1 +/- 24.2 muEq vs. 27.8 +/- 12.3 muEq during the 2nd hour, 110.9 +/- 14.4 muEq vs. 38.5 +/- 25.9 muEq during the 3rd hour, 116.4 +/- 12.1 muEq vs. 40.7 +/- 29.6 muEq during the 4th hour, p less than 0.001). However, cysteamine-induced duodenal ulcers were not alleviated by two doses of intramuscular verapamil administration (4 mg/kg x 2). It is presumed that suppression of gastric acid secretion may not be sufficient to reduce cysteamine-induced duodenal ulcer formation or that verapamil itself may have aggresive effects against duodenum. To illucidate the exact role of verapamil in cysteamine-induced duodenal ulcer, further studies would be needed.
Animals ; *Cysteamine ; Duodenal Ulcer/chemically induced/*drug therapy/pathology ; Gastric Acid/*secretion ; Injections, Intramuscular ; Male ; Rats ; Rats, Inbred Strains ; Stomach/drug effects/*metabolism ; Verapamil/*therapeutic use

OBJECTIVETo investigate the protective effect of verapamil and hypothermia on the spermatogenesis of rats after testicular torsion.

METHODSSixty healthy pubertal male Sprague-Dawley rats were equally divided into 5 groups: A (testis torsion), B (testis torsion + verapamil), C (testis torsion + hypothermia), D (testis torsion + verapamil + hypothermia) and E (control). After treatment, the left testis was removed for the observation of the histological changes under the microscope and measurement of the percentage of apoptotic cells by flow cytometry.

RESULTSHE staining showed disordered arrangement, reduced layers and decreased number of spermatogenic cells, apoptotic bodies, necrosis and partial invasion of inflammatory cells in all the groups but E, most obvious in Group A. The apoptosis rates of germ cells in Groups A, B, C, D and E were (32.11 +/- 2.20)%, (20.18 +/- 1.50)%, (20.02 +/- 1.90)%, (13.75 +/- 1.40)% and (8.56 +/- 0.90)%, respectively, and the Makler scores in the 5 groups were (14.47 +/- 1.35), (15.45 +/- 0.75), (15.48 +/- 0.75), (16.22 +/- 0.72) and (19.60 +/- 0.56), respectively, both with statistically significant differences (P < 0.01).

CONCLUSIONThe increased apoptosis of germ cells after testicular torsion-and-reposition may reduce the spermatogenesis of the testis. Either verapamil or local hypothermia can enhance testicular resistance against injuries, and the combination of the two can more efficiently prevent the germ cells from apoptosis.

Animals ; Apoptosis ; Hypothermia, Induced ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; physiopathology ; therapy ; Spermatic Cord Torsion ; physiopathology ; therapy ; Spermatogenesis ; Verapamil ; therapeutic use

Previous studies have demonstrated that enalapril and verapamil seem to attenuate the cyclosporine nephrotoxicity. However, the mechanisms have not been completely understood, especially on molecular events. The aim of this study was to examine the effect of individual or combined treatment on osteopontin, TGF-beta, endothelin-1 and procollagen alpha 1(I) mRNA expressions. Enalapril (50 mg/L in drinking water) and verapamil (0.5 mg/kg/day, subcutaneously), alone or in combination, were administered to rats with chronic cyclosporine nephrotoxicity (cyclosporine, 25 mg/kg/day, subcutaneously) (n = 5 each). Five rats treated with olive oil vehicle were used as control. After 4 weeks, biochemical parameters were measured, and renal cortical mRNA levels were evaluated by Northern blot analysis. Cyclosporine reduced renal creatinine clearance significantly and induced renal cortical osteopontin, TGF-beta, endothelin-1 and procollagen alpha 1(I) gene expressions around 13.5 +/- 1.3, 2.4 +/- 0.2, 1.5 +/- 0.1, 1.9 +/- 0.1 folds, respectively. Individual treatment with enalapril or verapamil significantly suppressed the osteopontin and TGF-beta mRNA expression, but not endothelin-1 and procollagen alpha 1(I). Combined treatment also inhibited the osteopontin and TGF-beta mRNA expression but there was no difference between combined and individual treatment. In conclusion, enalapril or verapamil significantly blunted the cyclosporine-induced osteopontin and TGF-beta gene expressions. However, combined treatment did not show any additive effect.
Angiotensin-Converting Enzyme Inhibitors/therapeutic use* ; Animal ; Calcium Channel Blockers/therapeutic use* ; Cyclosporine/adverse effects ; Drug Therapy, Combination ; Enalapril/therapeutic use* ; Enalapril/administration & dosage ; Endothelin-1/metabolism ; Endothelin-1/genetics ; Gene Expression Regulation/drug effects ; Immunosuppressive Agents/adverse effects ; Kidney Cortex/metabolism ; Male ; Nephritis/drug therapy* ; Nephritis/chemically induced ; Procollagen/metabolism ; Procollagen/genetics ; RNA, Messenger/analysis ; Rats ; Rats, Wistar ; Sialoglycoproteins/metabolism ; Sialoglycoproteins/genetics ; Transforming Growth Factor beta/metabolism ; Transforming Growth Factor beta/genetics ; Verapamil/therapeutic use* ; Verapamil/administration & dosage

To evaluate the anti-cicatricial and anti-restenosis effect of verapamil on anterior urethral stricture.
 Methods: A total of 32 patients received anterior urethral stricture were enrolled in this study. They were divided into 4 blocks according to the duration of previous urethral operations and dilations. Every block was further randomly divided into an experimental group and a control group. Experimental groups received 2 mL injection of verapamil around the anastomosis site of urethra before and after the surgery (2, 4, 6, 8, and 10 weeks after the surgery), while the control groups only received the anastomosis surgery. After surgery, maximal urinary flow rate (Qmax) was examined for all patients once the catheter was removed. In addition, they were also conducted palpation of urethral scar range. The sum of long transverse diameters of urethral scar was measured, and the narrowest urethral inner diameter was examined. The Qmax was rechecked and the urethral scar range was assessed by penis color Doppler elastography after 12 weeks of surgery. The above 4 indexes were used to evaluate the inhibitory effect of verapamil on urethral scar.
 Results: The length of palpated urethral scar in the Block 1 to 4 of the experimental groups was (22.75±1.03), (21.25±0.25), (20.75±1.03), and (20.0±0.58) mm, respectively; and those in the control groups (26.00±0.82), (24.5±1.04), (25.75±1.65), and (28.25±1.75) mm, respectively. The Qmax rates in the Block 1 to 4 of the experimental groups were (11.85±0.77), (11.33±0.81), (10.23±0.26), and (10.35±0.17) mL/s, respectively; and those in the control groups were (10.85±0.39), (10.50±0.76), (10.53±1.00), (12.60±0.39) mL/s, respectively. The Qmax rates in the Block 1 to 4 of the experimental groups were (11.73±0.87), (10.65±0.25), (10.23±0.19), and (10.35±0.29) mL/s, respectively; and those in the control groups were (8.05±0.28), (7.73±0.68), (7.53±0.92), and (9.60±0.32) mL/s, respectively. The narrowest diameters of urethral in the Block 1 to 4 of the experimental groups were (9.00±0.58), (7.50±2.89), (7.00±0.10), and (7.00±0.41) mm, respectively; and those in the control groups were (5.50±0.29), (5.00±0.41), (4.75±0.48), and (6.75±0.48) mm, respectively. The ultrasound strain ratio in the Block 1 to 4 of the experimental groups were 6.10±0.22, 6.10±0.17, 5.10±0.16, and 6.90±0.19, respectively; and those in the control groups were 8.00±0.25, 10.60±0.29, 11.30±0.16, and 8.90±0.33, respectively. Compared with the control groups, the experimental groups displayed smaller urethral scar range, less severe scarring, improved Qmax rates and wider inner diameters (all P<0.05).
 Conclusion: Urethral regional injection of verapamil intraoperatively or postoperatively can prevent overgrowth of urethral scar tissues after the transperineal anastomosis surgery, and reduce the tendency of postoperative restenosis of anterior urethral stricture.
Anastomosis, Surgical ; adverse effects ; Cicatrix ; diagnostic imaging ; drug therapy ; prevention & control ; Dilatation ; adverse effects ; Humans ; Male ; Penis ; diagnostic imaging ; Postoperative Complications ; diagnostic imaging ; drug therapy ; prevention & control ; Secondary Prevention ; Ultrasonography ; Urethra ; diagnostic imaging ; surgery ; Urethral Stricture ; prevention & control ; surgery ; Urination ; Urological Agents ; therapeutic use ; Verapamil ; therapeutic use