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Large dose procainamide therapy for ventricular tachyarrhythmia
Journal article   Peer reviewed

Large dose procainamide therapy for ventricular tachyarrhythmia

Allan M. Greenspan, Leonard N. Horowitz, Scott R. Spielman and Mark E. Josephson
The American journal of cardiology, v 46(3), pp 453-462
1980
DOI: https://doi.org/10.1016/0002-9149(80)90015-6
PMID: 6968154
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

The efficacy and toxicity of large dose procainamide therapy (500 to 1,500 mg given orally every 4 hours) for recurrent ventricular tachyarrhythmla were examined in 35 patients referred for electrophysiologic evaluation. In 16 patients procainamide was determined by programmed ventricular stimulation and serial drug testing to be the most effective agent. A long-term oral regimen was begun followed by periodic clinical evaluation and 24 hour ambulatory electrocardlographic monitoring for recurrence of symptomatic arrhythmia. In all 16 patients drug efficacy, acutely, correlated with specific plasma drug levels, which averaged 13.6 ± 8.6 μg/ml (mean ± standard deviation). Dose-dependent effects of procainamide at lower than the acute effective level were observed in six patients and included progressive slowing of the tachycardia and increasing ease of arrhythmia induction. In 14 of 16 patients, efficacy of the long-term oral regimen correlated with the acute effective plasma level. All 11 patients with plasma concentrations maintained at or above the acute effective plasma level have been free of symptomatic arrhythmia for up to 48 months, whereas all five patients with concentrations below the acute effective plasma level have had early symptomatic recurrences. Manifestations of acute toxicity, including hypotension, excessive Q-T prolongation or progression of infranodal conduction disturbances, were not observed. Chronic toxicity was limited to gastrointestinal disturbances in two patients (12.5 percent) and drug-induced lupus erythematosus in four (25 percent). It is concluded that large dose procainamide therapy is quite effective in the treatment of recurrent inducible ventricular tachyarrhythmia, and that the improved efficacy over small dose therapy may be achieved without an increased incidence of toxic side effects.

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Web of Science research areas
Cardiac & Cardiovascular Systems
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