Bretylium is not to be considered a first-line antiar-rhythmic agent. However, because of its ability to prolong the refractory period of Purkinje fibers and to elevate the electrical threshold to ventricular fibrillation, bretylium has been found useful in the treatment of life-threatening ventricular arrhythmias, especially when conventional therapeutic agents, such as lidocaine or procainamide, prove to be ineffective. In addition, bretylium is known to facilitate the reversal of ventricular fibrillation by precordial electrical shock. Its use should be limited to no longer than 5 days.
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