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Antiarrhythmic Effects and Tolerability of Mexiletine in Patients with Suspected Acute Myocardial Infarction

A Randomised, Double-Blind, Placebo-Controlled Prehospital Study

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Summary

The antiarrhythmic effects and tolerability of mexiletine 400mg administered intramuscularly to patients suspected of myocardial infarction before arrival at hospital, was evaluated in a randomised double-blind placebo-controlled multicentre trial. 99 patients received mexiletine, 97 placebo. In the mexiletine group, there was a slight, nonsignificant reduction in ‘significant arrhythmias’ [ventricular fibrillation, ventricular tachycardia or multifocal premature ventricular complexes (PVCs), or more than 10 PVCs/min] searched in continuous ECG recordings during patient transport. During the first 24 hours after admission to the coronary care unit, significantly more patients in the mexiletine group (28%) had signs of left ventricular failure than in the placebo group (15%). Mortality at 3 months was higher in the mexiletine group (20%) than in the placebo group (12.4%), but not significantly. Mexiletine serum concentrations on arrival at hospital and 3.5 hours after drug administration were in the commonly accepted therapeutic range. Intramuscular mexiletine 400mg does not appear suitable for the systematic prehospital prevention of ventricular arrhythmias in patients suspected of acute myocardial infarction.

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Correspondence to Dr M. Lievre.

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Lievre, M., Peyrieux, J.C., Leizorovicz, A. et al. Antiarrhythmic Effects and Tolerability of Mexiletine in Patients with Suspected Acute Myocardial Infarction. Drug Invest 2, 83–89 (1990). https://doi.org/10.1007/BF03258245

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Keywords

  • Acute Myocardial Infarction
  • Ventricular Fibrillation
  • Mexiletine
  • Coronary Care Unit
  • Antiarrhythmic Effect