TY - JOUR
T1 - Comparative hemodynamic effects of procainamide, tocainide, and encainide in severe chronic heart failure
AU - Gottlieb, Stephen S.
AU - Kukin, Marrick L.
AU - Medina, Norma
AU - Yushak, Madeline
AU - Packer, Milton
PY - 1990/3
Y1 - 1990/3
N2 - Many of the newer antiarrhythmic agents are said to cause minimal myocardial depression, but their hemodynamic effects have not been invasively evaluated and compared in patients with severe chronic heart failure. In a randomized, crossover study, the hemodynamic responses to single oral doses of procainamide (750 mg), tocainide (600 mg), and encainide (50 mg) given to 21 patients with severe chronic heart failure were compared. Cardiac performance decreased with all three drugs, but the magnitude of deterioration differed among the three agents. Stroke volume index decreased with procainamide (-5±1 ml/m2, p<0.001), tocainide (-7±1 ml/m2, p<0.001), and encainide (-8±1 ml/m2, p<0.001), but the decline was significantly greater with encainide than with procainamide (p<0.05). Similarly, left ventricular filling pressure increased with tocainide and encainide (+4±1 and +5±2 mm Hg, respectively; both p<0.05), but not with procainamide; the increase was significantly greater with tocainide and encainide than with procainamide (p<0.001). These deleterious hemodynamic effects were accompanied by worsening symptoms of heart failure in six patients with encainide and seven patients with tocainide but in only two patients with procainamide. Serum levels for all drugs were in the therapeutic range. In conclusion, although the three type I antiarrhythmic agents tested may all adversely affect left ventricular function in patients with heart failure, encainide and tocainide are more likely than procainamide to cause hemodynamic and clinical deterioration.
AB - Many of the newer antiarrhythmic agents are said to cause minimal myocardial depression, but their hemodynamic effects have not been invasively evaluated and compared in patients with severe chronic heart failure. In a randomized, crossover study, the hemodynamic responses to single oral doses of procainamide (750 mg), tocainide (600 mg), and encainide (50 mg) given to 21 patients with severe chronic heart failure were compared. Cardiac performance decreased with all three drugs, but the magnitude of deterioration differed among the three agents. Stroke volume index decreased with procainamide (-5±1 ml/m2, p<0.001), tocainide (-7±1 ml/m2, p<0.001), and encainide (-8±1 ml/m2, p<0.001), but the decline was significantly greater with encainide than with procainamide (p<0.05). Similarly, left ventricular filling pressure increased with tocainide and encainide (+4±1 and +5±2 mm Hg, respectively; both p<0.05), but not with procainamide; the increase was significantly greater with tocainide and encainide than with procainamide (p<0.001). These deleterious hemodynamic effects were accompanied by worsening symptoms of heart failure in six patients with encainide and seven patients with tocainide but in only two patients with procainamide. Serum levels for all drugs were in the therapeutic range. In conclusion, although the three type I antiarrhythmic agents tested may all adversely affect left ventricular function in patients with heart failure, encainide and tocainide are more likely than procainamide to cause hemodynamic and clinical deterioration.
KW - Antiarrhythmic agents
KW - Encainide
KW - Heart failure
KW - Procainamide
KW - Tocainide
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U2 - 10.1161/01.CIR.81.3.860
DO - 10.1161/01.CIR.81.3.860
M3 - Review article
C2 - 2106401
AN - SCOPUS:0025363524
SN - 0009-7322
VL - 81
SP - 860
EP - 864
JO - Circulation
JF - Circulation
IS - 3
ER -