Current Medical Research and Opinion (1996), 13, No. 6, 325

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The actions of talinolol, a B1-selective beta blocker, in cardiac arrhythmia and acute myocardial infarction I. Aßmann
Klinikum Erfurt GmbH, Klinik für Innere Medizin, Abteilung für Kardiologie, Psf. 595,
99012 Erfurt, Germany

Received: 15th November 1995

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Key Words
Address for correspondence

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It has long been known that beta-receptor blocking agents, including mainly cardioselective compounds, have favourable effects on tachyarrhythmias of various origins. They are the only substances known so far in the post-infarction phase to reduce significantly sudden cardiac deaths and to lower the rate of recurrent infarctions.7, 11, 14, 15, 31, 38, 42 High-risk patients seem to benefit most from the application of cardioselective beta blockers.11, 15 In the acute infarction phase as well, beta-receptor blockers display favourable effects in the majority of patients, especially as they reduce the myocardial-infarct size and lower the tendency to arrhythmias by protecting the heart from sympathetic stimulation. 11, 32, 40 The favourable effect on the variability of the heart rate must be stressed. 25 Furthermore, the early application of beta-receptor blockers is recommended today not only in the event of hyperkinetic reactivity, but also and particularly in so-called high-risk patients, although always respecting the contra-indication. In these patients, mortality is reduced markedly in the long-term treatment.

Key Words

B1-blockers – talinolol – acute myocardial infarction – cardiac arrhythmias

Cardiac arrhythmias

The cardioselective beta-receptor blocker talinolol (Cordanum®), which has been used for a long time in the treatment of various cardiovascular diseases and in tachyarrhythmias, is a b1-selective receptor blocker displaying lipophilic properties without intrinsic activity (ISA). Due to the b1-adrenergic blockade it induces, talinolol delays the conduction of stimuli in the AV node. In addition, the sino-atrial conduction time (SACT) is reduced and the sinus node automaticity impeded.2, 3, 24, 29, 30, 35

Electrophysiological findings

In patients whose hearts are healthy and show no cardiac arrhythmias, all investigators found, after intravenous administration of 10–20 mg talinolol i.v. within 3–5 min, a slight depression in sinus node recovery time (SNRT, i.e. the interval between the last atrial depolarisation induced by permanent atrial stimulation and the first spontaneous atrial potential, in ms). The prolongation comprises on average 164 ms. The duration of the sinus period is also increased slightly, though not significantly.2, 19, 24 In contrast, 5 mg propranolol i.v. induces a significant lengthening of the period duration by 150 ms.19, 35 Under the influence of talinolol, the sino-atrial conduction time (SACT, i.e. the conduction time from the sinus node to the atrium as determined by preliminary single atrial stimulation), as well as the atrial refractory time, are prolonged slightly, though not significantly. The delay in stimulus conduction brought about in the AV node (AH interval, global AV conduction with determination of Wenckebach's point, i.e. 1/1 conduction from the atria to the ventricles) of subjects with healthy hearts and not suffering from cardiac arrhythmia is not, on average, significantly prolonged, nor is the global AV conduction significantly influenced.2, 3, 24, 30

The majority of patients suffering from sick sinus syndrome, however, present a significant prolongation by approximately 80–260 ms, while the SNRT is extended, in some drastically, by talinolol3 (Table I; Figure 1). In addition, the global maximum AV conduction is, in some patients, significantly decreased. The AH interval is slightly prolonged in all trial groups (Figure 2). In patients with known AV lengthening, conduction in the AV node and the effective refractory period (ERP) are prolonged by talinolol as well,2, 24 although no higher-degree AV blockades were observed. A comparison with the effects brought about by 5 mg propranolol i.v. reveals a similar behaviour of the parameters mentioned, with the prolongation of SNRT under propranolol being, in some patients, obviously even more pronounced.24, 35

Under the influence of talinolol, patients with sinus tachycardias show a significant decrease in heart rate and AV conduction time, and a prolongation of the refractory periods in the atrium and in the AV node. The SNRT is not influenced to a significant degree.3 Neither in patients nor in healthy subjects is the intraventricular conduction (HV interval, QRS duration) significantly altered by talinolol. In electrophysiological investigations after intravenous application, talinolol thus displays effects which have been proven to occur also with other beta blockers. They are slightly less pronounced as compared with intravenous propranolol, especially with respect to an influence on AV conduction.

Graphical diagram
Fig. 1.– Maximal sinus node recovery time (SNRTmax) in patients with sick sinus syndrome (SSS) before and after administration of talinolol (20 mg i.v.).
Fig. 2.–AH time during atrial pacing in patients with sick sinus syndrome before after after administration of talinolol (20 mg i.v.).

Therapeutic effects on tachyarrhythmias during acute and long-term administration

Owing to its proven electrophysiological effects in the human body as well as in animals, talinolol has been used with much success in a large number of patients suffering from ventricular and supraventricular tachyarrhythmias related to coronary heart disease (CHD), but also to all other cardiovascular diseases and even hyperthyroidism. The drug is applied either as an acute parenteral administration, in most cases of 10–20 mg i.v., or chronically as an oral preparation with a mean dosage of 100–200 mg/day. 3, 5, 6, 12, 20, 21, 22, 26, 43

Table I.–Electrophysiological data before and after talinolol (20 mg i.v.) in patients with SSS
(ms)1034 ± 1951300 ± 607(+)
PA35 ± 942 ± 7(+)
StA64 ± 1864 ± 15
a106 ± 31116 ± 30+
b129 ± 43164 ± 52++
a47 ± 1049 ± 10
b52 ± 3449 ± 20
SACT(ms)140 ± 39159 ± 50
Refractory periods (ms)
ERPatr.278 ± 33284 ± 45
FRPatr360 ± 47377 ± 50(+)
ERPav396 ± 82433 ± 70
ERPav519 ± 59524 ± 64


S = significance, – = n.s., (+) = p <0.05,
+ = p <0.01. ++="p" < 0.001
a = at rest, b = during atrial pacing (100–110 min–1) (n = 13)


SSS = sick sinus syndrome
SACT = sino-atrial conduction time

Owing to its sinus node depression, talinolol is used preferably in patients with sinus tachyarrhythmias related to CHD, but also in the treatment of the hyperkinetic heart syndrome. The decrease in heart rate amounts in all investigations to approximately 15–20%. During tachycardiac atrial fibrillation or flutter, the ventricular rate is reduced on average by 15–25 b.p.m.12, 26 A conversion to sinus rhythm was observed to occur in 42% of the patients (given the drug (100–150 mg/day) in addition to quinidine and digitoxin) within 1–6 days, on average after 1.73 days.28 The attack rate in supraventricular tachycardias and paroxysmal

Table II.–Therapeutic effects with talinolol on cardiac arrhythmias (n = 342)
DiagnosisNumber of patientsTherapeutic effectsHR-reduction
Sinus tachycardia76++15–20%
Parox. supraventricular tachycardia39+
Supraventricular tachycardia12(Prevention ++)
Atrial flutter/fibrillation81+/++ (SR 30%)15–25%
ventricular tachycardia6–/++


Therapeutic effect: ++ very good; + good; – no effect HR = heart rate; VES = ventricular extrasystoles; SR = sinus rhythm
Table IIIa.–Comparison of efficacy on extrasystoles (n = 42) talinolol vs. metoprolol41
HR (l/min)72 ± 5 –9.1 ± 3.4 –9.6 ± 3.4**n.s.
VES1584 ± 2517–807 ± 1515* –713 ± 1346*n.s.
SVES1653 ± 1558–1088 ± 1450**–880 ± 1170**n.s.


* p <0.05; **p < 0.01; HR="heart" rate; VES="ventricular" extrasystoles; SVES="supraventricular" extrasystoles; n.s. not significant

Table IIIb.–Changes of Lown classification in 30 patients with ventricular extrasystoles41
After therapy with:
Before therapytalinololmetoprolol

(No significant difference between talinolol and metoprolol effects.)

atrial flutter is lowered in the majority of patients, while an interruption of supraventricular tachycardias can be brought about only in rare cases (Table II). Talinolol also exerts a significant positive influence on supraventricular and ventricular extrasystoles (SVES and VES), particularly in coronary heart disease when exercise-induced (cf. Figures 3a and b) or related to an increased activity of the sympathetic nervous system. The number and severity of ectopic beats in long-term ECGs was reduced to the same extent as under metoprolol, and was approximately 50% for VES and some 60% for SVES. There were no significant differences between the groups41 (Table III). In a double-blind trial involving a four-week application of 300 mg talinolol daily, Korkusko et al.20 found a significant reduction in SVES and VES, as compared with propranolol 100 mg/day, in patients with coronary heart disease versus placebo. A reduction of > 75% was considered to be a success, 31–74% a minor success and <30% a failure. In the majority of patients, both substances had positive effects, while supraventricular extrasystoles also reacted somewhat more readily in this trial (Table IV). The combination with other antiarrhythmics given in the event of tachyarrhythmias not responding to treatment also had positive effects in a large number of patients, who reported good tolerability and no undesired side effects9 (Table V).

Fig. 3(a)
Fig.3 (b)
Fig. 3(a) and 3(b).–ECG during exercise before (a) and after (b) 20 mg talinolol i.v. in a 56-year-old patient with coronary artery disease.
Table IV.–Influence of talinolol (300 mg/d) p.o. or propranolol (100 mg/d) on ventricular (VES) and supraventricular (SVES) extrasystoles20
Talinolol n = 20 vs placeboPropranolol n = 15 vs placebo
Reduction of arrhythmiasSVES(%)VES(%)SVES(%)VES(%)
1. O 75%15(75)12(60)7(46.7)5(33.3)
2. 30–75%3(15)4(20)6(40)6(40)
3. <30%2(10)4(20)2(13)4(27)
Table V.–Combination therapy with talinolol on tachyarrhythmias9
Number of patientsNumber of combinations234Very goodGoodNo effect
VES/VT151713223122 ST33300120 PSVT68530143 SVES11100010AF88233044


VES = ventricular extrasystoles; VT = ventricular tachycardia; ST = sinus tachycardia; PSVT = parox. supraventricular tachycardia; SVES = supraventricular extrasystoles; AF = atrial fibrillation

Even a higher-degree cardiac failure (NYHA II–III, partly even III–IV) in patients with tachyarrhythmias represents no contra-indication for talinolol. Even when administered parenterally, a deterioration of signs indicating heart failure was observed in only one case, while all other patients showed very good or good effects on arryhthmias, but no negative influence on the clinical symptoms of cardiac failure27 (Table VI).


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Address for correspondence:
Prof. Dr. med. Ingeborg Aßmann, Klinik für Innere Medizin, Abteilung für Kardiologie, Postfach 595, D-99012 Erfurt, Germany325

The actions of talinolol, a b1-selective beta blocker, in cardiac arrhythmia and acute myocardial infarctionI.
I. Aßmann

Current Medical Research and Opinion Vol. 13, No. 6, 1995

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