title: Adverse hemodynamic and clinical effects of encainide in severe chronic heart failure.
abstract: OBJECTIVE
  To evaluate the hemodynamic effects of the antiarrhythmic drug, encainide, in patients with severe chronic heart failure.
  
  
  METHODS
  Unblinded, before-after study.
  
  
  METHODS
  Referral center for patients with heart failure.
  
  
  METHODS
  Thirty patients with severe chronic heart failure and a left ventricular ejection fraction less than 40%.
  
  
  METHODS
  Invasive hemodynamic measurements were done (using a balloon-tipped thermodilution catheter) before and for 3 hours after a single oral dose of 50 mg of encainide.
  
  
  RESULTS
  Ninety to one hundred and twenty minutes after its administration, encainide produced a significant deterioration in cardiac performance, as reflected by a fall in cardiac index from 2.3 to 1.8 L/min.m2 body surface (mean change 0.5 +/- 0.1; P less than 0.001), a fall in stroke work index from 26 to 18 g.m/m2 (mean change 8 +/- 2; P less than 0.001), and an increase in left ventricular filling pressure from 19 to 22 mm Hg (mean change 3 +/- 2; P less than 0.05). These deleterious hemodynamic effects were accompanied by worsening symptoms of heart failure in 8 of the 30 patients. Serum levels of encainide and its metabolites, O-desmethylencainide and 3-methoxy-O-desmethylencainide, were within the therapeutic range in most patients.
  
  
  CONCLUSIONS
  Encainide can cause adverse hemodynamic and clinical effects in patients with severe chronic heart failure.
authors.affiliation: Mount Sinai School of Medicine, City University of New York, New York.
authors.forename: S S
authors.initials: SS
authors.lastname: Gottlieb
authors.forename: M L
authors.initials: ML
authors.lastname: Kukin
authors.forename: M
authors.initials: M
authors.lastname: Yushak
authors.forename: N
authors.initials: N
authors.lastname: Medina
authors.forename: M
authors.initials: M
authors.lastname: Packer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000813:Anilides / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy; D004417:Dyspnea / Q000139:chemically induced; D016700:Encainide; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D000813:Anilides; D000889:Anti-Arrhythmia Agents; D016700:Encainide