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Procainamide-induced sinus node dysfunction in patients with chronic renal failure

H G Kim, H S Friedman

    Chest
    |December 1, 1979
    PubMed
    Summary
    This summary is machine-generated.

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    Procainamide can cause sinus node dysfunction in patients with chronic renal failure, even with monitored blood levels. Discontinuing the drug restored normal heart rhythm, suggesting procainamide and its metabolite contribute to these cardiac issues.

    Area of Science:

    • Cardiology
    • Clinical Pharmacology
    • Nephrology

    Background:

    • Procainamide is an anti-arrhythmic drug used to manage ventricular arrhythmias.
    • Chronic renal failure can alter drug metabolism and excretion, increasing the risk of adverse effects.
    • Sick sinus syndrome (SSS) is a condition affecting the heart's natural pacemaker.

    Observation:

    • Two patients with chronic renal failure experienced transient sinus node dysfunction during procainamide therapy.
    • This dysfunction necessitated temporary pacemaker insertion.
    • Elevated procainamide and N-acetyl procainamide blood levels were observed.

    Findings:

    • Sinus node dysfunction occurred despite procainamide levels not typically associated with this adverse effect.
    • Discontinuation of procainamide led to the return of normal sinus rhythm.

    Related Experiment Videos

  • Elevated N-acetyl procainamide, a metabolite, may have contributed to the observed electrophysiologic changes.

    • Implications:

    • Procainamide may induce SSS-like symptoms in patients with impaired renal function.
    • Careful monitoring of procainamide and its metabolites is crucial in renally impaired patients.
    • This highlights potential drug-induced cardiac complications in chronic renal failure patients.