ajmaline and Emergencies

The efficacy of ajmaline (50-75 mg i.v.) or lidocaine (100-200 mg i.v.) in terminating persistent, haemodynamically stable ventricular tachycardia (VT) was compared in a prospective, randomized trial of 31 patients. There were no significant differences as to age, underlying heart disease, ejection fraction and rate of ventricular tachycardia between the two treatment groups. Ajmaline terminated VT in 10 of the 15 patients receiving it, lidocaine in only 2 of 16 (P less than 0.01). The frequency of VT was not significantly changed by lidocaine, while mean cycle length during VT changed under ajmaline from 369 +/- 82 ms to 452 +/- 11 ms (P less than 0.01). In contrast to lidocaine, QRS duration under ajmaline lengthened from 166 +/- 18 ms to 200 ms +/- 28 ms (P less than 0.01), but return cycles after tachycardia termination were similar (ajmaline, 863 +/- 296 ms; lidocaine, 917 +/- 367 ms). Both drugs were equally well tolerated, but in this series ajmaline was more effective in the acute treatment of persistent VT.

Topics: Ajmaline; Clinical Trials as Topic; Electrocardiography; Emergencies; Humans; Lidocaine; Prospective Studies; Random Allocation; Recurrence; Tachycardia; Time Factors

Bradycardic (heart rate<50/min) and tachycardic heart rhythm disturbances (100/min) require rapid therapeutic strategies. Supraventricular tachycardias (SVT) are sinus tachycardia, atrial tachycardia, AV-nodal reentrant tachycardia and tachycardia due to accessory pathways. Mostly SVT are characterized by small QRS complexes (QRS width<0.12 ms). It is essential to evaluate the arrhythmia history, to perform a good physical examination and to exactly analyze the 12-lead electrocardiogram. An exact diagnosis is then possible in >90% of SVT patients. Ventricular tachycardias have a broad QRS complex (>or=0.12 s), ventricular flutter and ventricular fibrillation are associated with chaotic electrophysiologic findings. For acute therapy, we will present the new concept of the "5A" that includes adenosine, adrenaline, ajmaline, amiodarone and atropine. Additional "B, C and D strategies" include betablocking agents, cardioversion as well as defibrillation. The "5A" concept allows a safe and effective antiarrhythmic treatment of all bradycardic and tachycardic arrhythmias as well as asystolia.

Topics: Adenosine; Adrenergic beta-Antagonists; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Atropine; Bradycardia; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Emergencies; Epinephrine; Heart Rate; Humans; Pacemaker, Artificial; Signal Processing, Computer-Assisted; Tachycardia

Up to now lidocain was regarded as remedy of first choice in life-threatening ventricular arrhythmias. According to more recent investigations in the emergency situation ajmalin showed itself superior to lidocain in the treatment of ventricular tachycardias. For the prophylaxis of primary ventricular fibrillation lidocain is still recommended, though despite numerous studies an effectiveness is not verified. The treatment of the primary ventricular fibrillation should always be performed by defibrillation as far as possible. The earlier it is performed the more successful is the measure. If a defibrillator is not at disposal an attempt with lidocain or ajmalin can bie made.

Topics: Ajmaline; Combined Modality Therapy; Electric Countershock; Electrocardiography; Emergencies; Heart Ventricles; Humans; Lidocaine; Myocardial Infarction; Tachycardia; Ventricular Fibrillation