Efficacy and safety of procainamide in preventing arrhythmias after coronary artery bypass surgery

• Published in: The American journal of cardiology 1996-11, Vol.78 (9), p.975-979
• Main Authors: Gold, Michael R., O'Gara, Patrick T., Buckley, Mortimer J., DeSanctis, Roman W.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Antiarythmic agents; Biological and medical sciences; Cardiac arrhythmia; Cardiovascular system; Coronary Artery Bypass - adverse effects; Coronary Disease - complications; Coronary Disease - surgery; Delayed-Action Preparations; Double-Blind Method; Drug therapy; Electrocardiography; Female; Humans; Male; Medical sciences; Middle Aged; Nausea - chemically induced; Pharmacology. Drug treatments; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Procainamide - adverse effects; Procainamide - therapeutic use; Surgery; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - prevention & control; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(96)00519-X

Arrhythmias are common after cardiac surgery and are associated with hemodynamic compromise, stroke, and prolonged hospitalization. Beta blockers prevent atrial fibrillation postoperatively, but there are few data regarding the prophylactic use of type I antiarrhythmic agents or the prevention of ventricular arrhythmias. Accordingly, we performed a randomized, double-blind, placebo-controlled study of the effects of oral procainamide on 100 patients undergoing elective coronary artery bypass surgery. Procainamide was received for 4 days; the dosage was adjusted for body weight. Patients receiving procainamide had a significant reduction in atrial fibrillation (16 vs 29 patient-days, p < 0.05) and ventricular tachycardia (2% vs 20%, p < 0.01). However, the incidence of atrial fibrillation was not significantly reduced (38% vs 26%). In the group achieving therapeutic serum procainamide levels, there was a reduction in all measured postoperative arrhythmias. No serious cardiac or noncardiac adverse events were noted during procainamide therapy, although there was a significant increase in the incidence of nausea. We conclude that procainamide reduces arrhythmias in the early postoperative period after coronary artery bypass surgery, most prominently in patients who achieve therapeutic serum levels. This was associated with no serious cardiac adverse reactions.