Periodic procainamide for paroxysmal tachycardia

Area of Science:

• Cardiology
• Clinical Pharmacology

Background:

• Paroxysmal tachycardia can be managed with intravenous procainamide.
• The efficacy of oral procainamide for self-termination of tachycardia episodes is less understood.

Purpose of the Study:

• To evaluate the effectiveness of a single oral dose of procainamide for terminating paroxysmal tachycardia.
• To assess the safety and efficacy of a self-administered oral procainamide regimen ('periodic procainamide') for tachycardia management.

Main Methods:

• Electrophysiologic study in 12 adolescent patients with various tachycardias.
• Administration of a single oral dose (25 mg/kg) of procainamide to assess termination efficacy.
• Prospective follow-up of patients instructed to use oral procainamide for tachycardia episodes.

Main Results:

• Oral procainamide terminated tachycardia in 11 of 12 patients, with termination times correlating with peak serum concentrations.
• Delayed or diminished serum concentrations were linked to treatment failure.
• During follow-up, 7 of 10 patients successfully used periodic procainamide to terminate tachycardia; 4 experienced no recurrence.

Conclusions:

• A single oral dose of procainamide is effective for terminating paroxysmal tachycardia in adolescents.
• The 'periodic procainamide' regimen shows promise for out-of-hospital self-management of tachycardia.
• Rapid tachycardia termination during evaluation predicts successful use of periodic oral procainamide.