Conventional antiarrhythmic agents

Lidocaine (lignocaine) is of value for the management of digitalis-related arrhythmias, and we employ it in cases of tachyarrhythmias of less than life-threatening severity (e.g. paroxysms of non-sustained ventricular tachycardia) (ADtm§D.aDd.Sm..ith...1995). Lidocaine is administered as serial intravenous 100-mg boluses every 3 to 5 min (to a total dose of 300 mg) until either a therapeutic effect or lidocaine toxicity develops. This may then be followed by continuous infusion of 15 to 50 pg/kg/min if further suppression of the arrhythmia is needed. Slow intravenous infusion of phenytoin (100 mg every 5 min, not to exceed a total dose of 1000 mg) is also useful for digitalis-toxic arrhythmias (e.g. ectopic automatic atrial tachycardia). Clinical experience with b-blockers, quinidine, and procainamide has been less favorable than that with lidocaine.

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