Cite this post as:
Rory Spiegel. EMNerd-The Case of the Dysrhythmic Heart. EMCrit Blog. Published on July 22, 2016. Accessed on November 30th 2021. Available at [https://emcrit.org/emcrit/65947/ ].
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Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.
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Unfortunately, iv procainamide is not widely available.
Interesting, everywhere I’ve worked it has been available. You just have to dust of the bottle a bit 🙂
Wasn’t much in the piece about how amio gained all the so-called market share. Can you expand more about how amio became the go to drug besides just saying it was from marketing? Thanks for your good work.
I posted this on twitter as well but thought I’d share here. In the AHA guidelines, procainamide is a IIa recommendation and amiodarone is a IIb recommendation. This is from 2010 and no update was made in 2015. From the AHA classification system: — Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Class IIa: Benefit >> Risk Weight of evidence/opinion is in favor of usefulness/efficacy. Class IIb: Benefit ? Risk Usefulness/efficacy is less well established by evidence/opinion. — I think this speaks to the effect of… Read more »
It is not available in my whole system. Many years ago I used 60 minute infusions of procainamide to convert new onset atrial fibrillation. It worked reasonably well.
Interesting dosing here — 5mg/kg amiodarone in a typical 70kg patient is 350mg over 20 minutes which is a large dose over a relatively short period of time. Not terribly surprised the authors found higher rates of adverse events in the amiodarone group with this dosing strategy.
Great point! I completely agree. Michelle Hines addresses these very same concern in her recent clinical pearl at https://em.umaryland.edu/educational_pearls/3059/
And while you can certainly say that the aggressive dosing may have lead to the high rate of adverse reactions observed, you cannot equally account for the obvious inferiority in the drugs efficacy. Lower doses may reduce the harms associated with amiodarone, I can’t imagine they would improve its efficacy
Thanks for writing!!
Thanks for the reply! I agree that we cannot equally account for the obvious inferiority in efficacy. This being said, one could hypothesize that the 9 patients in the amiodarone group who required DCCV during infusion (6 for severe hypotension, 3 for peripheral hypoperfusion/dyspnea with hypotension) could have possibly responded giving the infusion over a longer period of time. These are stable VT patients with constant monitoring (hopefully with pads placed already) so there is no reason that we MUST give it over such a short period of time. Purely hypothetical of course but if that was the case then… Read more »