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Abstract
Twenty-six patients (19 men and 7 women) with symptomatic ventricular tachycardia
(VT) were studied using invasive and noninvasive techniques to induce VT. Of the study
population, 12% had syncope and VT on Holter monitoring, 30% had cardiac arrest and
58% had symptomatic VT. All patients had antiarrhythmic agents stopped 5 half-lives
before evaluation and then had autonomic profile (upright tilt, cold pressor test,
exercise testing and hand grip) as well as programmed electrical stimulation studies
performed. Autonomic profile testing induced VT in 5 of 26 patients (19%) and in only
1 patient was the arrhythmia reproducibly induced. All 26 patients had VT induced
on electrophysiologic testing; 9 patients had nonsustained and 17 had sustained VT.
Lorcainide administered intravenously prevented VT induction in 20 of 26 patients
tested, whereas procainamide was effective in 11 of 24 patients. Ten of the 13 not
protected by procainamide were protected by lorcainide. Twenty patients were started
on long-term lorcainide therapy and followed up for 29 ± 3.4 months. Five patients
have discontinued therapy, 2 because of breakthrough arrhythmias, 2 because of severe
sleep-wake disturbances and 1 because of private physician preference. An additional
3 patients died during therapy because of myocardial infarction in 1, progressive
myopathy in 1 and sudden death in 1. Sixty percent of patients started on lorcainide
therapy have continued. In this patient population, noninvasive induction of VT is
not a sensitive or reproducible technique in assessing antiarrhythmic therapy. Furthermore,
when selected on the basis of electrophyslologic testing, lorcainide is a well-tolerated
and effective antiarrhythmic agent.
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Article info
Footnotes
☆This study was supported in part by Janssen Pharmaceutica, Inc. Dr. Somberg is an Established Investigator of the American Heart Association.
Identification
Copyright
© 1984 Published by Elsevier Inc.
