21 patients with acute
myocardial infarction and ventricular
arrhythmia of Lown class II-IIIB of acute onset received a short infusion of (50 mg/5 min)
ajmaline (Gilurytmal). 6 of the patients had normal kidney and liver function (Group 1), 4 patients had
acute renal failure and
hemodialysis treatment (Group 2), 4 patients had impaired hepatic function (Group 3), 3 patients had
cardiogenic shock (Group 4), and 4 patients had been pretreated with
phenobarbital for
seizures for at least 5 days (Group 5). A distribution half-life of 6 +/- 1 min and an elimination half-life of 95 +/- 6 min was determined in Group 1. The total plasma clearance was significantly lower in patients with impaired liver or cardiac function and significantly higher in Group 5, whereas impaired renal function did not affect total plasma clearance. After short infusion, ventricular
arrhythmia of Lown II-IIIB completely disappeared for at least 16 to 36 min (mean: 19 min), which was associated with an
ajmaline plasma level of 0.1-0.45 micrograms/ml. Additionally, steady-state plasma levels of
ajmaline were determined after continuous infusion of 10-50 mg/h to 16 patients (Group 6) with ventricular
arrhythmia of acute onset (Lown class IVA-V). Ventricular
arrhythmia completely disappeared or at least changed to lower Lown classes at
ajmaline plasma levels of 0.4-2.0 micrograms/ml. The
ajmaline plasma protein binding was 76 +/- 9%.
Ajmaline had a special affinity to
alpha 1-acid glycoprotein.