Hemodynamic effects of procainamide in patients with acute myocardial infarction and comparison with lidocaine

Miller, Richard R.; Hilliard, G.; Lies, James E.; Massumi, Rashid A.; Zelis, Robert; Mason, Dean T.; Amsterdam, Ezra A.

doi:10.1016/0002-9343(73)90164-2

Cited by 27 publications

(4 citation statements)

References 51 publications

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“…These haemodynamic studies suggested that the degree of cardiac depression, in patients with acute myocardial infarction, was greatest following disopyramide and least following lignocaine with flecainide occupying an intermediate position. These data are in general agreement with other reports of the effects of these drugs administered intravenously in acute myocardial infarction and stable coronary artery disease (Miller et al, 1973;Beck et al, 1978;Burton et al, 1976;Rahimtoola etal., 1971;Schumacher etal., 1968;Grossman et al, 1969;Cameron et al, 1984;Hulting et al, 1976, Kotter et al, 1980 al., , Serruys et al, 1983Josephson et al, 1984). Unfortunately the lack of standardisation of experimental protocols between these various studies makes direct comparisons problematical.…”

Section: Discussionsupporting

confidence: 93%

“…Although the individual haemodynamic effects of many anti-arrhythmics have been well characterised (Grossman et al, 1969;Miller et al, 1973;Hulting & Rosenhamer, 1976;Kotter et al, 1980;Serruys et al, 1983;Josephson et al, 1984), comparison of their actions is more difficult to assess. This stems from their circulatory assessment in independent laboratories with differing administration regimens, dosages and methodology.…”

Section: Introductionmentioning

confidence: 99%

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Comparative haemodynamic effects of intravenous lignocaine, disopyramide and flecainide in uncomplicated acute myocardial infarction.

Silke¹,

Frais²,

Verma³

et al. 1986

Brit J Clinical Pharma

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A prospective study evaluated the comparative haemodynamic effects of three Class I antiarrhythmics (lignocaine Class 1B, disopyramide Class 1A and flecainide Class 1C) in 30 patients with uncomplicated acute myocardial infarction. Three groups, each of 10 patients, were allocated to lignocaine (Group I) 1.5 mg kg‐1 i.v. loading dose over 10 min followed by infusion at 3 mg kg‐1 h‐1, disopyramide (Group II) or flecainide (Group III), both administered as a 1.0 mg kg‐1 i.v. loading bolus over 10 min followed by a 1.6 mg kg‐1 h‐1 infusion for 120 min. The plasma levels of each drug were in the described therapeutic range. Lignocaine decreased cardiac index (‐0.3 l min‐1 m‐2 (9%); P less than 0.05) and stroke volume index (‐5 ml m‐2 (11%); P less than 0.01). Systemic blood pressure, heart rate and systemic vascular resistance index were unchanged. There was a small increase (+3 mm Hg (30%); P less than 0.01) in pulmonary artery occluded pressure (PAOP). Both disopyramide and flecainide increased systemic blood pressure; the maximum increases for mean blood pressure were +10 mm Hg (11%) and +4 mm Hg (4%) respectively. Both drugs reduced cardiac index (‐0.5 l min‐1 m‐2 (16%): −0.4 l min‐1 m‐2 (11%)) and stroke volume index (‐11 ml m‐2 (25%): −5 ml m‐2 (11%)). There were increases in heart rate (+13: +5 beats min‐1) pulmonary artery occluded pressure (+2: +3 mm Hg) and systemic vascular resistance index (+696: +275 dyn s cm‐5 m2).(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Comparative haemodynamic effects of intravenous lignocaine, disopyramide and flecainide in uncomplicated acute myocardial infarction.

Silke¹,

Frais²,

Verma³

et al. 1986

Brit J Clinical Pharma

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“…The duration and magnitude of the reductions in SI and CI after the administration of DE in the dose given were more marked than the corresponding changes reported for lidocaine in thercpeutic doses (3,17). The same holds true when the present results are compared with reports on the effect of diphenylhydantoin (9) and procainamide following acute myocardial infarction (12).…”

Section: Discussionsupporting

confidence: 87%

Hemodynamic and Electrocardiographic Effects of Disopyramide in Patients with Ventricular Arrhythmia

Hulting

Rosenhamer

1976

Journal of Internal Medicine

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“…In contrast, Miller et aJ. 28 reported that intravenous lidocaine and procainamide induced no significant cardiodepression in patients with acute myocardial infarction. Burton et al ,6 however, found small but significant deteriorations in hemodynamic performance after this drug.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic dose-response effects of flecainide in acute myocardial infarction with and without left ventricular decompensation

Jackson¹,

Verma²,

Frais³

et al. 1985

Clin Pharmacol Ther

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We evaluated the hemodynamic effects of the class I antiarrhythmic flecainide in 20 patients within 18 hours of an acute myocardial infarction. Equal numbers of patients with normal (group 1) or decompensated (group 2) ventricular function were studied. Both groups received flecainide, 1 mg/kg, as an intravenous bolus over 10 minutes, followed by infusion (1.6 mg/kg/hr) over the next 120 minutes. Plasma concentrations increased linearly with the cumulative flecainide dosage in both groups. There was no difference between the groups in the plasma levels reached, which were within the recognized antiarrhythmic range for flecainide (200 to 1000 ng/ml) throughout the infusion. The hemodynamic effects of flecainide for each group were decreases in systolic blood pressure (maximum 3% fall in group 1 and 8% fall in group 2), cardiac index (9% fall in group 1 and 18% fall in group 2), stroke volume index (13% fall in group 1 and 23% fall in group 2), stroke work index (14% fall in group 1 and 27% fall in group 2), with an increased heart rate (8% rise in group 1 and 5% rise in group 2), pulmonary artery occluded pressure (27% rise in group 1 and 21% rise in group 2), and systemic vascular resistance (11% rise in group 1 and 18% rise in group 2). Diastolic and mean arterial blood pressures did not change. Our data demonstrate that flecainide induced significant cardiodepression in both groups of patients. These effects were not significantly greater in patients with adequately controlled heart failure. These data suggest that the mild negative inotropic properties of flecainide in patients with recent myocardial infarction are comparable to those described for other class I antiarrhythmics.

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Hemodynamic effects of procainamide in patients with acute myocardial infarction and comparison with lidocaine

Cited by 27 publications

References 51 publications

Comparative haemodynamic effects of intravenous lignocaine, disopyramide and flecainide in uncomplicated acute myocardial infarction.

Comparative haemodynamic effects of intravenous lignocaine, disopyramide and flecainide in uncomplicated acute myocardial infarction.

Hemodynamic and Electrocardiographic Effects of Disopyramide in Patients with Ventricular Arrhythmia

Hemodynamic dose-response effects of flecainide in acute myocardial infarction with and without left ventricular decompensation

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