Document Detail

The effect of intravenous procainamide on the HV interval at electrophysiologic study.
MedLine Citation:
PMID:  10387139     Owner:  NLM     Status:  MEDLINE    
The His bundle electrogram recorded at electrophysiologic study clearly differentiates atrioventricular (AV) node disease from distal conduction system disease. The distal conduction system may be tested further by infusing procainamide (10-15 mg/kg) intravenously. High-grade distal AV block or prolongation of the HV interval <80 ms was defined as an abnormal response to this test. We retrospectively reviewed the medical records of 79 patients who underwent electrophysiologic study with intravenous procainamide. An abnormal response to procainamide was observed in only 3% of 37 patients with a normal baseline HV (</= ms), in 48% of 27 patients with mild HV prolongation (56 to 70 ms), and in all 15 patients with moderate HV prolongation (<70 ms) (P <0.0001 for the trend). Procainamide induced high-grade AV block in 4 of 28 patients (14%) studied for syncope and in 1 of 51 patients (2%) studied for ventricular tachycardia. Syncope as the indication for electrophysiologic study (P = 0.05) and left bundle branch block morphology (P = 0.03) were predictors of high-grade AV block; baseline HV and QTc intervals were significantly prolonged in patients who developed AV block with procainamide. We identified a strong linear correlation (R = 0.85) between post-drug and baseline HV intervals, with a regression slope of 1.17 +/- 0.09 and an intercept (+/- standard error) of 5.8 +/- 5.0 ms. This linear response to procainamide and published prospective studies support pacing syncope patients with baseline HV <70 ms. Therefore, procainamide infusion during the electrophysiologic study of patients with undifferentiated syncope should be reserved for those with mild HV prolongation from approximately 55 to 70 ms.
S E Girard; T M Munger; S C Hammill; W K Shen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  3     ISSN:  1383-875X     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-09-24     Completed Date:  1999-09-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  129-37     Citation Subset:  IM    
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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MeSH Terms
Arrhythmias, Cardiac / diagnosis*,  physiopathology
Heart / physiopathology*
Heart Arrest, Induced
Injections, Intravenous
Middle Aged
Procainamide / diagnostic use*
Reference Values
Retrospective Studies
Syncope / diagnosis*
Tachycardia, Ventricular / diagnosis
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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