Per ACLS guidelines, stable ventricular tachycardia can be treated with either IV Amiodarone or IV Procainamide. Clinically it appears that Amiodarone has been the preferred agent, although both drugs have received a class II recommendation. There is one study in particular, the PROCAMIO Trial, that compares the effectiveness of both drugs and their side effects in the treatment of stable Vtach. This prospective study essentially compared the effectiveness of 5mg/kg IV Amiodarone over 20 minutes vs 10mg/kg IV Procainamide over 20 mins. Before the PROCAMIO trial, the only trial that compared these two drugs was a retrospective multicenter cohort trial of 90 patients. It should be noted that the study had a limited sample size of 74 patients (12 of which were excluded due to protocol violations or the development of an exclusion criteria) however it was the FIRST multicenter, prospective, randomized controlled trial comparing IV procainamide vs IV amiodarone.
In conclusion, Procainamide was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min compared to Amiodarone. The most significant side effect amongst both drugs was severe hypotension requiring immediate electrical cardioversion (that occurred less with Procainamide), however there were no deaths that occurred during this study.
Bottom line: Consider grabbing Procainamide as your first line therapy in patients with stable ventricular tachycardia.
- Ortiz M et al. Randomized Comparison of Intravenous Procainamide vs. Intravenous Amiodarone for the Acute Treatment of Tolerated Wide QRS Tachycardia: the PROCAMIO Study. Eur Heart J 2016.
- Marill KA et al. Amiodarone or Procainamide for the Termination of Sustained Stable Ventricular Tachycardia: An Historical Multicenter Comparison. Acad Emerg Med 2010; 17: 297 – 306.