Prospective comparison of intravenous quinidine and intravenous procainamide in patients undergoing electrophysiologic testing

Byline: Peter T. Holzberger, Mark L. Greenberg, Mary Claire Paicopolis, Tom P. Ozahowski, Paul C. Ho, Gerald T. O'Connor Abstract: Background Intravenous procainamide hydrochloride is frequently used in the acute care setting and during electrophysiologic testing, but intravenous quinidine gluconate is rarely used because of concerns about its safety. This study prospectively compares the hemodynamic and electrophysiologic effects of these agents in patients undergoing electrophysiologic testing. Methods and Results Sixty-five consecutive patients with inducible ventricular tachyarrhythmias were prospectively treated with either intravenous quinidine gluconate or intravenous procainamide hydrochloride in an alternating unblinded fashion. The hemodynamic and electrophysiologic effects of these two drugs were compared. Seven (22%) patients assigned to intravenous quinidine gluconate and eight (24%) patients assigned to intravenous procainamide hydrochloride were rendered noninducible for ventricular tachyarrhythmias. Four (13%) patients assigned to intravenous quinidine gluconate were unable to complete the infusion compared with none (p = 0.05) assigned to intravenous procainamide hydrochloride. Otherwise, the overall hemodynamic and electrophysiologic effects of the two drugs were similar. Conclusions Intravenous quinidine gluconate is a reasonable alternative to intravenous procainamide hydrochloride in patients requiring a parenteral type IA antiarrhythmic agent. (Am Heart J 1998;136:49-56.) Author Affiliation: Lebanon, N.H Article History: Received 24 October 1997; Accepted 5 February 1998 Article Note: (footnote) [star] From the Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center., [star][star] Reprint requests: Peter T. Holzberger, MD, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756., a 4/1/89409