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Here we report, for the first time in Cuba, the use of gene therapy to evaluate the positive therapeutic action and safety of a plasmid expressing the vascular endothelial growth factor isoform 121 gene (pVEGF121), in a pilot clinical trial of ischemic cardiac arrhythmia. Six patients irrespective of their sex or race, with ages between 49 and 71, were included. They were refractory to conventional medical treatment and discharged as candidates for surgical revascularization procedures or interventionist cardiology. The pVEGF121 was administered as a single dose of 0.5 mg/mL, by intramyocardial route in four sites of the ischemic area (250 mL/site), previously defined by SPECT imaging by the surgical team and during a minimal left thoracotomy. Patients showed clinical improvements six months after therapy and partial regression in the treated ischemias, a better health status and quality of life, increased survival probabilities. Plasmid transfection and VEGF expression were also evidenced. The main adverse events reported comprised two deaths by myocardial infarction, probably due to perioperative complications derived from surgical risks and the critical status of the patients. Several parameters indicated that pVEGF121 administration did not cause adverse events per se, requiring less invasive myocardial treatment alternatives to evaluate this product in other phases. [ABSTRACT FROM AUTHOR]