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European Heart Journal 1997 18(5):866-869;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Facilitating influence of procainamide on conversion of atrial flutter by rapid atrial pacing

A. Heisel, J. Jung, M. Stopp and H. Schieffer

Medizinische Universitätsklinik, Innere Medizin III, Universitätskliniken des Saarlandes Homburg/Saar, Germany

revised 26 November 1996; accepted 27 November 1996.

Correspondence: Armin Heisel, MD, Medizinische Universitätsklinik, Innere Medizin III, Universitätskliniken des Saarlandes, D-66421 Homburg/Saar, Germany

Abstract

In a prospective, double-blind, randomized, placebocontrolled study we investigated the facilitating influence of intravenous procainamide on conversion of atrial flutter by rapid atrial pacing.

Fifty consecutive patients with spontaneous sustained atrial flutter were 1:1 randomized into two homogenous groups: group A received 10 mg. kg–1 procainamide intravenously, group B placebo. After infusion there was a significant (P<0·01) lengthening of the flutter cycle with respect to baseline in group A, exceeding the flutter cycle length of the control group (P<0·05). The overall success rate of rapid atrial pacing in restoring sinus rhythm was significantly higher after pre-treatment with procainamide compared to placebo (100% vs 76% P<0·05): 20 patients of group A reverted immediately after pacing to sinus rhythm, the remaining five after a brief episode of atrial fibrillation. In the placebo group, 16 patients showed a prompt conversion to sinus rhythm and three after transient atrial fibrillation. In the remaining six patients, due to sustained pacing-induced atrial fibrillation, direct current cardioversion was necessary. After administration of procainamide a less aggressive stimulation protocol with significantly (P<0·01) longer paced cycles to interrupt atrial flutter was achievable.

In conclusion, intravenous procainamide augments the efficacy of atrial pacing to convert atrial flutter to sinus rhythm.

Key Words: Atrial flutter • pacing • procainamide


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