Oral procainamide as pharmacological treatment of recurrent and refractory ventricular tachyarrhythmias: A single-center experience

Abstract

BACKGROUND Antiarrhythmic therapy for recurrent ventricular arrhythmias in patients who have undergone catheter ablation, and in whom amiodarone and/or beta-blockers were ineffective or contraindicated, is a controversial issue.OBJECTIVE The present study sought to evaluate the efficacy and tolerability of oral procainamide in patients with recurrent ventricular arrhythmias when the standard therapy strategy had failed.METHODS All patients treated with procainamide for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in our institution between January 2010 and May 2019 were enrolled. The primary endpoint was the total number of implantable cardioverter-defibrillator (ICD) interventions after the beginning of procainamide therapy. Secondary endpoints were the total number of VTs and VFs recorded on the ICDs' controls and discontinuation of therapy. The events occurring during procainamide treatment were compared with a matched-duration period before the initiation of therapy with procainamide. Patients therefore served as self-controls.RESULTS A total of 34 consecutive patients (32 male, 94.1%; mean age 74.4 6 9.7 years) were included in the retrospective analysis. The mean time of procainamide treatment was 12.9 6 13.7 months (median 9 [2-20] months). The mean dose of procainamide was 1207 6 487 mg/day. Procainamide therapy significantly decreased ICD interventions (median 5 [0-22.5] vs 15.5 [3-32.25], P , .05). Procainamide also decreased the total number of VT/VF episodes (median 5.5 [0.75-30] vs 19 [7.5-30], P , .05). Only 3 patients (8.8%) presented severe side effects (dyspnea or hypotension), requiring discontinuation of therapy.CONCLUSION Oral procainamide was associated with a significant decrease in ICD therapies and ventricular arrhythmias, showing an acceptable profile of tolerability.

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

“… 275 , 276 In a recent small single-centre observational study, oral procainamide reduced ICD therapies in patients with VT refractory to other AADs, including amiodarone. 277 However, severe side effects, including a drug-induced lupus erythematosus-like syndrome, are of concern. Of note, procainamide is not available in many countries.…”

Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs

“…Similar to its use in acute situations, procainamide has largely been studied as an AAD in patients with VT refractory to amiodarone. In this setting, a 34-patient study by Toniolo et al showed that use of procainamide after failure of previous AAD resulted in 10% reduction of ICD therapies [ 19 ]. Of note, this study has a high proportion of concomitant ablations (18 of 34 patients) that may serve as a significant confounder.…”

“…Sotalol demonstrated early efficacy in suppression of ventricular ectopy and suppression of inducible ventricular tachyarrhythmias [ 113 , 114 , 115 ]. The relative efficacy of sotalol was unknown until the ESVEM trial compared serial efficacy of seven antiarrhythmic medications through electrophysiologic testing and Holter monitoring in patients with ventricular tachyarrhythmias [ 19 ]. Sotalol was the most frequently efficacious mediation, in 43% of patients, with the lowest rate of arrhythmia recurrence and improvement in all-cause mortality.…”