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In IO patients with severe myocardial infarction and left ventricular failure, bretylium tosylate was used in the treatment of ventricular arrhythmias which had proved refractory to lignocaine and procainamide; 6 cases had also failed to respond to phenytoin. In 7 patients stable sinus rhythm was achieved and 5 of these survived to leave hospital. For the period during which bretylium was used, the only observed side-effect was sinus bradycardia.The anti-arrhythmic effect of bretylium tosylate was first described in I965 when Leveque reported its protective effect in experimentally-induced atrial fibrillation in dogs. In the following year, Bacaner (1966) showed that bretylium protected the dog heart against ventricular fibrillation by raising the fibrillation threshold, and later demonstrated (Bacaner, I968a) that it was more effective in this respect than lignocaine, procainamide, quinidine, phenytoin, and propranolol. Since then,