COMPARISON
OF PROCAINAMIDE AND LIDOCAINE IN TERMINATING SUSTAINED MONOMORPHIC VENTRICULAR
TACHYCARDIA
Gorgels
AP, et al. Am J Cardiol 1996 Jul 1;78(1):43-6.
BACKGROUND:
Efficacy of procainamide and lidocaine in terminating spontaneous monomorphic
ventricular tachycardia (VT) was assessed in a randomized parallel study.
SETTING
& RESULTS: Patients with acute myocardial infarction and those with poor
hemodynamic tolerance of VT were excluded. Procainamide 10 mg/kg was given
intravenously with an injection speed of 100 mg/min, and lidocaine was
administered at an intravenous dose of 1.5 mg/kg in 2 minutes. Fourteen
patients were randomized to lidocaine and 15 to procainamide. Termination
occurred in 3 of 14 patients after lidocaine and in 12 of 15 patients after
procainamide (p <0.01). Procainamide stopped 8 of 11 VTs not responding to
lidocaine, and lidocaine stopped 1 of 1 not responding to procainamde. Of a
total of 41 VT episodes, 4 of 15 responded to lidocaine and 20 of 26 to
procainamide (p <0.01). Because of VT recurrences, 16 patients could be
studied repeatedly with drugs given in the reversed order. This resulted in a
total of 55 trials of 79 drug injections. Lidocaine terminated 6 of 31 VTs and
procainamide 38 of 48 (p <0.001). The protocol was stopped in 4 cases
because of adverse effects. A comparison of the QRS width and QT interval
before and at the end of the injection revealed significant lengthening of
these values after procainamide but no change after lidocaine.
CONCLUSION:
In conclusion, procainamide is superior to lidocaine in terminating
spontaneously occurring monomorphic VT.