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European Heart Journal 1986 7(2):150-157;
Copyright © 1986 by the European Society of Cardiology.
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© 1986 The European Society of Cardiology

Acute haemodynainic effects of the antiarrhythmic agent pirmenol in cardiac patients: a comparison with lidocaine

M. S. NIEMINEN, L. K. TOIVONEN, V. MANNINEN and M. H. FRICK

Cardiovascular Laboratory, First Department of Medicine, University Central Hospital Helsinki, Finland

Received 17 July 1985; revised 11 October 1985; .

Address for correspondence: Laun K. Toivonen, MD, Cardiovascular Laboratory, First Department of Medicine, Helsinki University Central Hospital, SF-00290 Helsinki 29, Finland

Abstract

The acute haemodynamic effects of pirmenol, a new Class 1 antiarrhythmic agent, were investigated in a double-blind comparison with lidocaine and placebo. Three groups of 10 patients each received either pirmenol as a 50 mg intravenous injection followed by a 2.5 mg min–1 infusion, or lidocaine as a 75 mg injection followed by a 3 mg min–1 infusion, or placebo. Mean plasma pirmenol concentrations during the 30 min infusion period were 2.3–2.5 mg l–1, and were considered to be therapeutically effective.

Compared to measurements taken during a baseline phase of 15 min duration, pirmenol increased heart rate by 10 beats min–1 (P<0.001) and mean arterial pressure (MAP) by SmmHg (P<0.001). It also increased systemic vascular (P<0.05) and pulmonary arterial resistances (P<0.01). Left ventricular end-diastolic pressure (LVEDP) was not increased significantly. Cardiac index and left ventricular work index remained unchanged. Lidocaine induced a comparable increase in MAP (6mmHg; P<0.001) and elevated LVEDP (2.8 mmHg; P<0.05) and did not affect left ventricular work index. Echocardiographic left ventricular ejection fraction was reduced more by pirmenol ( – 0.05; P<0.001) than by lidocaine (–003; P<0.05), but the greater reduction may partly be explained by the increase in heart rate. Pirmenol did not induce excessive circulatory responses or side-effects in any patient.

Intravenous administration ofpirmenol results in increased heart rate and afterload but has little effect on preload. The myocardial depressant effect is relatively slight, and comparable to that of lidocaine.

Key Words: Pirmenol • haemodynamics • heart disease • lidocaine


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