Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study

Abstract

AimsIntravenous procainamide and amiodarone are drugs of choice for well-tolerated ventricular tachycardia. However, the choice between them, even according to Guidelines, is unclear. We performed a multicentre randomized open-labelled study to determine the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex (probably ventricular) tachycardia.Methods and resultsPatients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min). The primary endpoint was the incidence of major predefined cardiac adverse events within 40 min after infusion initiation. Of 74 patients included, 62 could be analysed. The primary endpoint occurred in 3 of 33 (9%) procainamide and 12 of 29 (41%) amiodarone patients (odd ratio, OR = 0.1; 95% confidence interval, CI 0.03–0.6; P = 0.006). Tachycardia terminated within 40 min in 22 (67%) procainamide and 11 (38%) amiodarone patients (OR = 3.3; 95% CI 1.2–9.3; P = 0.026). In the following 24 h, adverse events occurred in 18% procainamide and 31% amiodarone patients (OR: 0.49; 95% CI: 0.15–1.61; P: 0.24). Among 49 patients with structural heart disease, the primary endpoint was less common in procainamide patients (3 [11%] vs. 10 [43%]; OR: 0.17; 95% CI: 0.04–0.73, P = 0.017).ConclusionsThis study compares for the first time in a randomized design intravenous procainamide and amiodarone for the treatment of the acute episode of sustained monomorphic well-tolerated (probably) ventricular tachycardia. Procainamide therapy was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min.

Amiodarone for sustained stable ventricular tachycardia in the prehospital setting

“…More recently, intravenous procainamide has been compared with amiodarone in patients with stable VT. 15 In a hospital study, 74 patients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min) and data was available for 62 patients. Tachycardia terminated within 40 min in 22 (67%) procainamide and 11 (38%) amiodarone patients (OR = 3.3; 95% CI 1.2-9.3; P = 0.026).…”

Procainamide Versus Amiodarone for Stable Ventricular Tachycardia

“…A prior retrospective study failed to demonstrate a difference in efficacy between amiodarone and procainamide for cardioversion of stable VT. The trial discussed here is the only known randomized controlled trial (RCT) that compares the two drugs for this purpose. This multicenter study randomized 74 patients to receive procainamide (10 mg/kg over 20 minutes) or amiodarone (5 mg/kg over 20 minutes) for stable wide‐QRS complex tachycardia presumed to be VT.…”

Wide QRS Complex Tachycardia

“…However, in sustained monomorphic wide QRS complex tachycardia, procainamide showed a higher proportion of tachycardia termination and less hypotension than amiodarone. 3 Moreover, the elimination half time of amiodarone is much longer than that of procainamide (up to 180 days versus up to 4 hours, respectively), and this may limit the prompt detection of preexcited signs when sinus rhythm is restored.…”