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Effect of propranolol on ventricular repolarization and refractoriness: Role of beta-blockade versus direct membrane effects

  • Focus On Arrhythmias
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Summary

The purpose of this study was to define the role of beta-adrenergic blockade and direct membrane effects in the ability of dl-propranolol to alter ventricular repolarization and refractoriness in the intact heart. The effective refractory period (ERP) and the local Q-T interval were measured at an epicardial site in the left ventricle in 14 open-chest dogs anesthetized with alpha-chloralose. Beta-adrenergic influences were eliminated in seven dogs (group 1) by stellate transection and nadolol (0.5 mg/kg IV), and enhanced in seven dogs (group 2) by stellate transection and stimulation of the left ansae subclavia. Each dog received an initial beta-blocking dose of propranolol (0.5 mg/kg) followed by a second, cumulative dose of 5.0 mg/kg. In group 1 dogs, there was no significant change in either the ERP or local Q-T interval in response to the first dose of propranolol. In group 2 dogs, left stellate stimulation significantly shortened the ERP (20±2 msec) and the local Q-T interval (17±4 msec). The first dose of propranolol prolonged these parameters to values not different from prestimulation control values. There was no change in the H-V interval, QRS complex duration, or diastolic threshold (DT) in either group after the initial propranolol dose. The second dose of propranolol significantly shortened the ERP (5±1 msec) and the local Q-T interval (11±2 msec) in both groups. This dose also significantly increased the DT, H-V interval, and QRS complex duration. In three additional nadolol-treated dogs, a single 5 mg/kg dose of propranolol shifted the entire strength-interval curve 4 to 7 msec earlier into electrical diastole. The data indicate that a beta-blocking dose of propranolol prolongs repolarization and refractoriness only when adrenergic input is elevated. In the absence of beta-adrenergic influences, high doses of propranolol shorten repolarization and refractoriness. This latter effect may be due to a direct membrane effect of the drug.

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Authors and Affiliations

  1. Department of Medicine, Loyola University Medical Center, Maywood, Illinois

    David E. Euler Ph.D. & Patrick J. Scanlon

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  1. David E. Euler Ph.D.
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  2. Patrick J. Scanlon
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Euler, D.E., Scanlon, P.J. Effect of propranolol on ventricular repolarization and refractoriness: Role of beta-blockade versus direct membrane effects. Cardiovasc Drug Ther 1, 605–612 (1988). https://doi.org/10.1007/BF02125746

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