Procainamide atrial flutter

First-degree heart block Exercise caution if the patient exhibits or develops first-degree heart block while taking procainamide dosage reduction is advised. If the block persists despite dosage reduction, evaluate the continuation of procainamide on the basis of current benefit vs risk of increased heart block. Predigitalization for atrial flutter or fibrillation Cardiovert or digitalize patients with atrial flutter or fibrillation prior to procainamide administration to avoid enhancement... 

Procainamide is an effective antiarrhythmic agent when given in sufficient doses at relatively short (3-4 hours) dosage intervals. Procainamide is useful in the treatment of premature atrial contractions, paroxysmal atrial tachycardia, and atrial fibrillation of recent onset. Procainamide is only moderately effective in converting atrial flutter or chronic atrial fibrillation to sinus rhythm, although it has... 

The effects of disopyramide are very similar to those of procainamide and quinidine. Its cardiac antimuscarinic effects are even more marked than those of quinidine. Therefore, a drug that slows atrioventricular conduction should be administered with disopyramide when treating atrial flutter or fibrillation. 

Stambler BS, Wood MA, Ellenbogen KA. Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and fibrillation electrophysiological determinants of enhanced conversion efficacy. Circulation 1997 96( 12) 4298-4306. 

Volgman AS, et al. Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation. J Am Coll Cardiol 1998 3 I (6) 1414 1419. 

The adverse effects of intravenous procainamide (400 mg up to three times infused over 10 minutes) have been reported in 60 adults with atrial flutter or fibrillation in a comparison with ibutihde (2). The adverse effects were headache in 11%, hypotension in 11%, flushing in 3.1%, dizziness in 3.1%, and hypesthesia in 3.1%. The mean fall in systolic blood pressure was about 20 mmHg and occurred at 30-35 minutes after infusion the corresponding fall in diastolic blood pressure was 10 mmHg. However, in seven patients there was severe hypotension, with a fall in diastolic blood pressure of up to 67 mmHg in three cases withdrawal of the infusion was required and these patients were treated with intravenous fluids, dopamine, or both. In the severe cases the hypotension occurred during or immediately after the infusion of procainamide. 

Procainamide (e.g., Pronestyl) II If Premature atnal depolarization, atrial fibrillation, Wolff-Parkinson-White, ventricular tachycardia, atrial flutter, premature ventricular depolarization. Fewer Gl effects and weaker anticholinergic effects than quinidine, but similar cardiac toxicity. Lupus-like syndrome and other hypersensitivity reactions. 

Atrial fibrillation/flutter- Procainamide has been used to convert atrial fibrillation/flutter to sinus rhythm. 

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