Author + information
- Received May 26, 1987
- Revision received July 23, 1987
- Accepted August 13, 1987
- Published online January 1, 1988.
- Gur C Adhar, MD∗∗,
- Charles D Swerdlow, MD, FACC†,
- Barbara L Lance, RN∗,
- Deborah Clay, RN†,
- Gust H Bardy, MD, FACC∗ and
- H.Leon Greene, MD, FACC∗
- ↵∗Address for reprints: Gur C. Adhar, MD, Harborview Medical Center, 325 Ninth Avenue, ZA-35, Seattle, Washington 98104.
Eighty-two patients with drug-resistant ventricular tachycardia or fibrillation were treated with oral tocainide. Treatment in 54 patients, all with inducible ventricular tachycardia or fibrillation at baseline electrophysiologic testing, was based on the results of invasive electrophysiologic testing. Twenty-eight additional patients with frequent spontaneous ventricular tachycardia or no inducible arrhythmia during electrophysiologic testing were treated on the basis of the findings of electrocardiographic (ECG) Holter monitoring.
Tocainide was effective in 7 (13%) and partially effective in 5 (8%) of the 54 patients in the electrophysiologic study group and was effective in 17 (61%) of the 28 patients in the ECG monitoring group. History of previous myocardial infarction and failure of response to lidocaine correlated with failure to respond to tocainide. Side effects were common both during initial therapy and during long-term treatment and necessitated discontinuation of tocainide therapy in 17% of the patients. At a mean follow-up period of 14 months, 13 patients are still receiving tocainide and are arrhythmia-free.
In conclusion, the usefulness of oral tocainide in the management of drug-refractory sustained ventricular tachycardia or fibrillation is limited because of its low effectiveness and frequent side effects.
☆ This work was supported in part by the American Heart Association Grantin-Aid, Washington Affiliate, no. 86-WA-518, National Institutes of Health-Heart, Lung, and Blood Institute grant 36170-01, Bethesda, Maryland, the Harry H. Law Memorial Fund and the Jacob P. Glastra Memorial Fund, Seattle, Washington. This study was presented in part at the 36th Annual Scientific Session of the American College of Cardiology, March 1987, New Orleans, Louisiana.
- Received May 26, 1987.
- Revision received July 23, 1987.
- Accepted August 13, 1987.