PubMed · 5581708
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E Glassman. 1971. Direct current cardioversion.. https://doi.org/10.1016/0002-8703(71)90170-0
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Efficacy of procainamide and lidocaine in terminating spontaneous monomorphic ventricular tachycardia (VT) was assessed in a randomized parallel study. 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. In conclusion, procainamide is superior to lidocaine in terminating spontaneously occurring monomorphic VT.
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Most of the paroxysmal forms of supraventricular tachycardia are reentry tachycardias in origin with either an AV-nodal reentry (AVNRT; approx. 50%) or an AV reentry circuit via accessory pathway (AVRT; approx. 30%) as the anatomical basis of tachycardia. The therapeutic options include either drug therapy or transcatheter radiofrequency ablation. In asymptomatic patients, where supra-ventricular tachycardia or WPW syndrome was documented incidentally, an expectative approach without therapy is usually recommended. However, if frequent tachycardia recurrences or severe clinical symptoms (syncope, pre-syncope make treatment mandatory, medical therapy with either betablockers, calcium antagonists or digoxin should be tried if AV-nodal reentry tachycardia is the mechanism (no evidence of WPW syndrome on the 12-lead ECG). In patients with symptomatic WPW syndrome or drug refractory AV-nodal reentry tachycardia, transcatheter radiofrequency ablation with its good results and low complication rate is the therapy of choice. The treatment modality is particularly indicated in young patients who otherwise would need lifelong drug therapy. In contrast, supraventricular tachycardias with badly defined anatomical substrate, such as multifocal atrial tachycardias or atrial fibrillation, should in the first place be treated medically and not by radiofrequency ablation.