The use of procaine amide and lidocaine in the treatment of cardiac arrhythmias.

External electrical current in the treatment of ventricular tachycardia.

Intravenous procaine amide in the treatment of cardiac arrhythmias

THERE has been a resurgence of interest in cardiac arrhythmias in the past few years. Many excellent papers have been published reporting clinical and experimental investigations of the nature and treatment of these disturbances. From this wealth of data and detail one fact emerges with startling clarity, namely, that digitalis and quinidine still retain their positions of preeminence as antiarrhythmic drugs. The work and experience of recent years have resulted in a better understanding of the action and methods of employment of these two drugs and, in addition, have brought into prominence various agents of lesser importance but of occasional great value. It is the purpose of this paper to review briefly the current status of the management of cardiac arrhythmias. A simplified list of recommended drugs and dosages is appended in the Table. It is obvious that not all arrhythmias need to be treated. Sinus arrhythmia, sinus bradycardia, A-V nodal rhythms (including interference dissociation), and

Treatment of cardiac arrhythmias.

When the operation of pulmonary valvotomy was started by Brock in 1948, one of the difficulties met was understanding the changes in the rhythm and action of the heart. It was thought that continuous electrocardiographic tracings might help in this way and so make it possible to lessen their incidence. Such tracings have generally been taken since then and in the present paper we wish to discuss the findings during 70 direct operations for pulmonary stenosis. The patients fall into five groups: (I) those with Fallot's tetralogy (a) who had valvotomy for a valvular stenosis (13 cases); (b) who had infundibular resection (19 cases); (c) who had both these procedures (8 cases); and (II) those with pulmonary valvular stenosis with a closed ventricular septum (a) who were acyanotic (17 cases); and (b) who were cyanotic from a right-to-left interatrial shunt (13 cases). The records were analysed separately for these five groups, partly because the mortality was greater in groups I(b) and II(b). They were, however, very similar so are all discussed together though any special differences that were observed between the groups are commented on. Similar records have been taken in many patients having mitral valvotomy and our findings (Campbell and Reynolds, 1952) will be compared. Although operations for pulmonary stenosis are, on the whole, more dangerous than those for mitral stenosis, probably because the surgical approach is through the right ventricle instead of through the left auricle, we find that the electrocardiographic changes are in some ways less than those during mitral valvotomy. The continuous tracings during angiocardiography (Reynolds, 1953) are also of interest for comparison.

https://heart.bmj.com/content/heartjnl/16/1/57.full.pdf

Electrocardiographic changes during operations for pulmonary stenosis.

Recent developments in cardiac surgery and modern methods of cardiac investigation have emphasized the need for a drug that will control the irritability of the heart, particularly ventricular arrhythmias. In clinical cardiology also a satisfactory drug for the treatment of ventricular tachycardia has still to be found, one, moreover, that can be administered parenterally with safety. The usefulness of procaine has been limited by its side effects, hypotension and excessive central nervous stimulation. The amide of procaine has not these disadvantages to the same degree, and early reports (Mark et al, 1950; Newman and Clark, 1950) have emphasized its value in the control of arrhythmias. It is the purpose of this paper to report on the efficacy of procaine amide in the control both of clinical arrhythmias and of those occurring during mechanical interference with the heart, either during cardiac catheterization or during cardiac surgery.

https://heart.bmj.com/content/heartjnl/14/4/470.full.pdf

Procaine amide in the control of cardiac arrhythmias.

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Procaine amide in the control of cardiac arrhythmias.