Abstract Twenty patients with ventricular arrhythmias were treated with procaine amide to determine an antiarrhythmic plasma drug concentration range and to observe procaine amide's effect on blood...

Intermittent intravenous procaine amide to treat ventricular arrhythmias. Correlation of plasma concentration with effect on arrhythmia, electrocardiogram, and blood pressure.

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.

Large dose procainamide therapy for ventricular tachyarrhythmia

The incidence of ventricular fibrillation during and after temporary experimental occlusion of the left anterior descending coronary artery or its branches was studied in 351 dogs. A standardized procedure of thirty-minute temporary occlusion of this artery was employed in 330. There is usually a critical period after twelve and up to fifteen minutes of ischemia which is characterized by a tendency to arrhythmia: extrasystoles, singly or in runs, ventricular tachycardia, or both extrasystoles and tachycardia if not a fatal ventricular fibrillation. Several instances of transient ventricular fibrillation were observed. Of 239 animals surviving thirty minutes of occlusion, 71 per cent developed ventricular fibrillation immediately after release of the artery, while only 28 per cent of 330 animals developed fibrillation during the occlusion. The re-establishment of blood flow to an area of the myocardium made ischemic for thirty minutes by occlusion of the anterior descending coronary artery is more likely to precipitate ventricular fibrillation than is the period of ischemia itself. Various drugs were evaluated in 324 dogs. Quinidine was the most effective drug in affording protection from ventricular arrhythmia during (7 per cent) and following (47 per cent) occlusion. Procaine, procaine amide and Apresoline offered good protection during the ischemic period. Apresoline and Regitine also reduced the incidence (44 and 37 per cent) of ventricular fibrillation upon reopening the ligature. Of the other drugs tested, only one, pendiomide, showed significant protection (52 per cent incidence). Systemic arterial pressures did not predict the onset of ventricular arrhythmia. Electrical countershock accomplished cardiac resuscitation in 75 per cent of the fibrillating dogs. From these experiments, quinidine appears to be the drug of choice in the prophylaxis of fatal ventricular arrhythmias.

Ventricular Fibrillation During and After Coronary Artery Occlusion Incidence and Protection Afforded by Various Drugs

The Wolff-Parkinson-White syndrome: pharmacologic effects of procaine amide.

In 16 patients with intraventricular conduction delay (IVCD) and cardiac arrhythmias, procaine amide (PA) was infused intravenously at rates of 30-40 mg/min until a maximum dose of 750-1,000 mg was administered. His bundle electrograms and plasma PA levels were obtained every 5 min during infusion and for 25 min thereafter. The mean peak PA level (10.2 ± 3.4 µg/ml) was achieved at the end of infusion. Mean control A-V nodal conduction times (A-H: 99.5 ± 34 msec) and A-H at peak PA levels (90 ± 15.3) did not differ significantly. However, the mean infranodal conduction time (H-Q) at peak PA (68.1 ± 14.8 msec) was significantly higher than control measurements (57.6 ± 13 msec) (P < 0.001), with a mean percent increase of 18% (11 msec), and maximal prolongation of H-Q occurred at peak PA blood levels. There was no statistically significant correlation between maximum absolute or percent change in H-Q and control H-Q, control QRS duration, or peak PA levels. One patient with sinus bradycardia had further decr...

Electrophysiologic Effects of Procaine Amide in Patients with Intraventricular Conduction Delay

Procaine amide, a new synthetic analogue of procaine, has marked antiarrythmic activity and is relatively stable in the body. It is effective when administered orally or intravenously, and has few toxic effects in therapeutic doses. The drug has been used successfully in the suppression of ventricular premature contractions and in the interruption of ventricular tachycardia. Some patients treated successfully with procaine amide had been given quinidine to the point of toxicity without affecting the aberrant rhythm. Procaine amide appears to be less effective in interrupting auricular than ventricular arrhythmias.

Use of procaine amide in cardiac arrhythmias.

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Use of procaine amide in cardiac arrhythmias.