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Eur Heart J. 2016 Jun 28. pii: ehw230. [Epub ahead of print]

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

Author information

  • 1Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • 2Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain.
  • 3Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain.
  • 4Emergency Department, Hospital Clinic, Barcelona, Spain.
  • 5Emergency Department, Hospital Universitario de La Princesa, Madrid, Spain.
  • 6Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
  • 7Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain almendral@secardiologia.es.

Abstract

AIMS:

Intravenous 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 RESULTS:

Patients 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).

CONCLUSIONS:

This 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.

KEYWORDS:

Acute treatment; Amiodarone; Procainamide; Ventricular tachycardia

PMID:
27354046
DOI:
10.1093/eurheartj/ehw230
[PubMed - as supplied by publisher]
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