title: Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study.
abstract: OBJECTIVE
  Intravenous procainamide and amiodarone are drugs of choice for well-tolerated ventricular tachycardia. However, the choice between them, even according to Guidelines, is unclear. We performed a multicentre randomized open-labelled study to determine the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex (probably ventricular) tachycardia.
  
  
  RESULTS
  Patients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min). The primary endpoint was the incidence of major predefined cardiac adverse events within 40 min after infusion initiation. Of 74 patients included, 62 could be analysed. The primary endpoint occurred in 3 of 33 (9%) procainamide and 12 of 29 (41%) amiodarone patients (odd ratio, OR = 0.1; 95% confidence interval, CI 0.03-0.6; P = 0.006). Tachycardia terminated within 40 min in 22 (67%) procainamide and 11 (38%) amiodarone patients (OR = 3.3; 95% CI 1.2-9.3; P = 0.026). In the following 24 h, adverse events occurred in 18% procainamide and 31% amiodarone patients (OR: 0.49; 95% CI: 0.15-1.61; P: 0.24). Among 49 patients with structural heart disease, the primary endpoint was less common in procainamide patients (3 [11%] vs. 10 [43%]; OR: 0.17; 95% CI: 0.04-0.73, P = 0.017).
  
  
  CONCLUSIONS
  This study compares for the first time in a randomized design intravenous procainamide and amiodarone for the treatment of the acute episode of sustained monomorphic well-tolerated (probably) ventricular tachycardia. Procainamide therapy was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min.
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martín
authors.affiliation: Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arribas
authors.affiliation: Emergency Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Coll-Vinent
authors.affiliation: Emergency Department, Hospital Universitario de La Princesa, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Del Arco
authors.affiliation: Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Peinado
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Almendral
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D009202:Cardiomyopathies / Q000150:complications; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011342:Procainamide / Q000008:administration & dosage* / Q000009:adverse effects; D017180:Tachycardia, Ventricular / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D011342:Procainamide; D000638:Amiodarone
keywords: Acute treatment; Amiodarone; Procainamide; Ventricular tachycardia