Tachycardia: procainamide increased termination rates.

Clinical bottom line (level 1b)

  1. Patients with monomorphic ventricular tachycardia who were given procainamide, were more likely to have termination of the tachycardia than those given lidocaine (NNT = 2 at 15 minutes) .
Gorgels et al: American Journal of Cardiology 1996; 78: 43-46
Expires August 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: General hospital, The Netherlands

29 patients (aged mean 61 years, 86% male) spontaneous monomorphic ventricular tachycardia

Excluded if
  • severe heart failure or hypotension during ventricular tachycardia
  • polymorphic ventricular tachycardia, especially torsades de pointes
  • acute myocardial infarction
  • ventricular tachycardia due to digitalis intoxication
  • extracardiac disorders such as severe liver or kidney disturbances, alcoholism or epilepsy


    • Note:
  • A number of patients received oral antiarrhythmics at the time of the study, but they were equally divided between the two groups.
  • Patients who were entered a second time were not randomised again, but just had the alternative initial therapy. These results are not presented here.


    • Control Group: (n = 14, 14 analysed): lidocaine hydrochloride injection as an i.v. bolus of 1.5 mg per kg in 2 minutes
    Experimental Group: (n = 15, 15 analysed): procainamide as a bolus of 10 mg per kg at an injection rate of 100 mg per minute
    Protocol was stopped when ventricular tachycardia was terminated. When tachycardia was not terminated within 5 minutes after the test drug was given, the other one was injected. If it still was not terminated within 15 minutes, the protocol was stopped and treatment according to the opinion of the attending cardiologist was given.
    100% followed for 15 minutes
    Outcome notes:
    • termination of ventricular tachycardia : on first presentation

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    termination of ventricular tachycardia 15 minutes 3
    (21.4%)    		 12
    (80.0%)    		 -273%
    (-950% to -33.0%)    		 -58.6%
    (-88.1% to -29.1%)    		 2
    (1 to 3)

  • Of the 11 ventricular tachycardias not responding to lidocaine, procainamide stopped 8. Of the 3 nonresponders to procainamide, the protocol was stopped because of hypotension in 1 and acceleration of tachycardia in another. The other patient had the tachycardia stopped by lidocaine.

    • Citation

    1. Gorgels APM, van den Dool A, Hofs A, et al: Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. American Journal of Cardiology 1996; 78: 43-46
    Contributor: Clare Wotton and Bob Phillips, August 1999
    Reviewer:

    Clinical Question.
    Patient monomorphic ventricular tachycardia
    Intervention or Exposure procainamide
    Comparison lidocaine
    Outcome termination of tachycardia