Procainamide beats amiodarone for VT

August 29, 2016

Short Attention Span Summary

Wide, fast, and hemodynamically stable
For stable ventricular tachycardia (VT), procainamide was a lot better than amiodarone at terminating the arrhythmia.  Adverse effects were far more common the amiodarone group.  This was a small, underpowered, unblinded RCT that was stopped early for super-slow recruitment.

Spoon Feed
I still conclude, in stable VT, procainamide is better than amiodarone.

I found this study on Justin Morgenstern’s blog.

This one is a veritable #FOAMed-fest: The Bottom Line gives…well, the bottom line, EM:RAP has audio, and EM Nerd geeks out with a cleansing rant about big pharma that I enjoyed very much.

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Abstract

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

Ortiz M1, Martín A2, Arribas F3, Coll-Vinent B4, Del Arco C5, Peinado R6,Almendral J7; PROCAMIO Study Investigators.

Collaborators: (24)

Peinado R, Madridano O, Serrano L, García Alberola A, Martín A, Alvarez M, Sánchez L, Villacastín J, G-Armengol J, Suero C, Muñoz J, Atienza F,Ruiz F, Ruiz E, Moya A, Laín N, Aguilar J, Castellanos E, Salguero R,Pedrote A, Caballero A, Carbajosa J, Ortega Liarte JV, Cancio M.

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.

© The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

PMID: 27354046 [PubMed – as supplied by publisher