Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Cardiodepressant effects of mexiletine in patients with severe left ventricular dysfunction
From the Division of Cardiology, Department of Medicine, University of Maryland School of Medicine Baltimore, Maryland, U.S.A.
Received 13 August 1990; revised 10 December 1990; .
Correspondence Stephen S. Gottlieb. MD. Division of Cardiology. The University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Maryland 21201, L.S.A.
Abstract
Mexiletine is thought to exert minimal negative inotropic actions, but its effects have not been evaluated in patients with severe congestive heart failure. The haemodynamic response to an oral loading dose of mexiletine (400 mg) was assessed in 20 patients with severe chronic heart failure. Mexiletine caused marked haemodynamic deterioration, with stroke work index decreasing in 18 of the patients. Two hours after mexiletine, mean cardiac and stroke work indexes decreased by 15% and 25% respectively (both P < 0.001), while heart rate and systemic vascular resistance increased by 10% and 20%. respectively (both P <0.05). Simultaneously, left ventricular filling pressure and right atrial pressure increased by 37% and 36%, respectively (both P <0.001), but mean arterial pressure did not change. Furthermore, clinical deterioration, with onset of dyspnoea at rest, developed in five patients at the time of peak haemodynamic effect. Plasma mexiletine concentrations were within the accepted therapeutic range of 0.5 to 2.0 .µg. ml–1 in all but two of the patients. Nevertheless, the plasma concentration was an important determinant of haemodynamic effect. The stroke work index decreased by 38% in the patients with a mexiletine level above the median value of 1.3 µg . ml–1 (range 25 to 56%), but only 13% (range 15 to 43) in patients with lower plasma concentrations. In conclusion, although mexiletine may cause cardiodepressant effects in any patient with severe left ventricular dysfunction, dosing which results in a high (but still therapeutic) plasma level is more likely to cause haemodynamic deterioration.
Key Words: Mexiletine • congestive heart failure • haemodynamics • antiarrhythmic agents
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Steendijk, S. A. F. Tulner, J. J. Schreuder, J. J. Bax, L. van Erven, E. E. van der Wall, R. A. E. Dion, M. J. Schalij, and J. Baan Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H723 - H730. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Kornet, J.J. Schreuder, E.T. van der Velde, and J.R.C. Jansen The volume-dependency of parallel conductance throughout the cardiac cycle and its consequence for volume estimation of the left ventricle in patients Cardiovasc Res, September 1, 2001; 51(4): 729 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Steendijk, E. Staal, J. W. Jukema, and J. Baan Hypertonic saline method accurately determines parallel conductance for dual-field conductance catheter Am J Physiol Heart Circ Physiol, August 1, 2001; 281(2): H755 - H763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Kornet, J.J Schreuder, E.T van der Velde, J Baan, and J.R.C Jansen A new approach to determine parallel conductance for left ventricular volume measurements Cardiovasc Res, December 1, 2000; 48(3): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. W. Wallace, M. B. Ratcliffe, P. S. Nose, W. Bellows, W. Moores, M. T. McEnany, K. Flachsbart, and D. T. Mangano Effect of induction and reperfusion with warm substrate-enriched cardioplegia on ventricular function Ann. Thorac. Surg., October 1, 2000; 70(4): 1301 - 1307. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Schmidlin, S. Aschkenasy, P. R. Vogt, J. Schmidli, R. Jenni, and E. R. Schmid Left ventricular pressure-area relations as assessed by transoesophageal echocardiographic automated border detection: comparison with conductance catheter technique in cardiac surgical patients Br. J. Anaesth., September 1, 2000; 85(3): 379 - 388. [Abstract] [Full Text] [PDF]
|
|