Bretylium in severe ventricular arrhythmias associated with digitalis intoxication

Bretylium has been well-recognized as an effective antiarrhythmic agent for acute ventricular arrhythmias, but its use is believed to be contraindicated in digitalis intoxication. We report of two patients in whom digitalis-induced malignant ventricular arrhythmias were refractory to lidocaine. One patient had had repeated episodes of ventricular fibrillation associated with digitoxin and quinidine intoxication, and one patient had had malignant premature ventricular beats associated with digoxin intoxication. Cardiac electrical activity was paced in both instances. In the two patients, ventricular arrhythmias rapidly resolved, and no side effect was encountered. These observations support the administration of bretylium for severe digitalis-induced ventricular arrhythmias.