Malignant ventricular arrhythmias in eclampsia: A comparison of labetalol with dihydralazine

• Published in: American journal of obstetrics and gynecology Vol. 168; no. 4; pp. 1292 - 1296
• Main Authors: Bhorat, Ismail E., Naidoo, Datshana P., Rout, Christopher C., Moodley, Jack
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.04.1993; Elsevier
• Subjects: Adolescent; Adult; Antihypertensive agents; Biological and medical sciences; Cardiovascular system; Dihydralazine - therapeutic use; Eclampsia; Eclampsia - complications; Eclampsia - drug therapy; Electrocardiography, Ambulatory; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Labetalol - therapeutic use; Medical sciences; Pharmacology. Drug treatments; Pregnancy; Tachycardia, Ventricular - prevention & control; ventricular tachycardia; β-blockade; ventricular tachycardia; β-blockade; Eclampsia; Human; Vasodilator agent; Intravenous administration; Pregnancy disorders; Arrhythmia; Treatment efficiency; Cardiovascular disease; Pregnancy toxemia; Excitability disorder; Chemotherapy; Treatment; Heart disease; Antihypertensive agent; Paroxysmal ventricular tachycardia; Comparative study; Beta blocking agent
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(93)90383-T

Objective: Our aim was to assess the impact of R-adrenergic blockade during the peripartum period on the previously observed high incidence of ventricular arrhythmias in eclamptic parturients. Study Design: An open, randomized comparison of intravenous labetalol versus dihydralazine was conducted in 40 eclamptic subjects in the peripartum period. Cardiac rhythm was assessed by blinded analysis of a 24-hour Holter record by means of the Lown classification of arrhythmias. Results: There was a significantly higher incidence of serious ventricular arrhythmias in patients receiving dihydralazine (81 %) than in those receiving labetalol (17%, p < 0.0001). Patients receiving labetalol showed a significant decrease in mean heart rate (p < 0.0001), whereas patients receiving dihydralazine showed a significant increase (p < 0.0001). Conclusion: The introduction of R-adrenergic blockade into peripartum hypertensive management of eclampsia significantly reduced the incidence of dangerous ventricular arrhythmias. Myocardial oxygen supply/demand ratio may be improved by β-blockade.