Why the study?
Does bretylium tosylate safely prevent cardiac arrhythmias compared to lidocaine in patients with acute myocardial infarction?
Does bretylium tosylate safely prevent cardiac arrhythmias compared to lidocaine in patients with acute myocardial infarction?
Bretylium tosylate is contraindicated for routine use in preventing infarction arrhythmias due to substantial and unpredictable hypotensive effects.
Answers are grounded in this paper and cite their sources.
Bretylium-associated hypotension warrants clinical caution in acute MI; this cohort study leaves open need for randomized safety data versus lidocaine.
The effects of bretylium tosylate in managing acute myocardial infarction were studied in 16 patients within 24 hours from the onset of symptoms and were compared to those of lidocaine in a comparable group of 15 patients. Both drugs were equally effective in preventing cardiac arrhythmias during the 48 hours of trial. No deleterious hemodynamic effects were associated with lidocaine treatment. However, marked supine hypotension developed in seven patients treated with bretylium. No changes occurred simultaneously in heart rate, left ventricular ejection time, or central venous pressure. The occurrence of hypotension correlated with a poor initial hemodynamic state. The substantial and unpredictable circulatory effects of bretylium in acute myocardial infarction contraindicates its routine use in the prevention of infarction arrhythmias.
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K Luomanmäki (1975) studied this question.
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