Lorcainide in the prophylaxis of ventricular arrhythmias in acute myocardial infarction

Lorcainide, a new class I antiarrhythmic agent, was administered intravenously to eight patients with acute myocardial infarction for 24 hours, and thereafter given by mouth, 200 mg daily for ten days. Ten control infarction patients were given lidocaine 3 mg/min during the first 24 hours and the oral betablocking agent, pindolol, for the following ten days. The two groups were comparable with respect to age, sex, onset-admission interval, and site and size of infarction. Ventricular premature beats were monitored with a 24-hour continuous ECG recording on days 1, 6 and 10. Complex ventricular premature beats were common during the first 24 hours of infarction; their occurrence and severity were similar in both groups, as judged by the Lown grading system. The plasma levels of lorcainide after the 24-hour infusion ranged 72-144 ng/ml (mean 95 ng/ml). On the sixth day, 12 hours after previous oral dose, lorcainide plasma levels ranged 11-82 ng/ml (mean 42 ng/ml). No major adverse effects were noticed, mild insomnia being the most disturbing reaction. It is concluded that lorcainide is an acceptable alternative to lidocaine in the treatment of ventricular arrhythmias in the acute stage of myocardial infarction. It has the advantage of being effective by oral route, too.