High-dose procainamide in chronic renal failure

A patient with chronic renal failure who experienced symptomatic ventricular tachycardia was treated successfully with procainamide (PA) after numerous dosage adjustments to optimize his clinical response and serum PA and NAPA concentrations. Efforts to maintain total combined serum levels at 20-30 micrograms/ml led to sustained ventricular ectopy whenever the serum PA levels decreased to less than 8 micrograms/ml.