Fifty patients with
drug-refractory (failed 7 +/- 2 other
drug trials) sustained
ventricular tachycardia or fibrillation were treated with oral
lorcainide. Twenty-three patients underwent programmed stimulation both before and after oral
lorcainide, and all 23 remained inducible, although
ventricular tachycardia cycle length was prolonged and mean arterial pressure was higher.
Lorcainide was discontinued in 23 patients prior to hospital discharge because of death in four patients, side effects in five patients, spontaneous clinical
arrhythmia recurrence in six patients, and
ventricular tachyarrhythmias induced at electrophysiologic study in eight patients. Twenty-seven patients were discharged on an average dose of 169 +/- 56 mg twice a day, including 15 in whom
ventricular tachycardia remained inducible. During long-term follow-up the
drug was discontinued in 15 patients; three because of side effects, three because of clinical nonfatal
arrhythmia recurrence, two who selected other alternative
therapy, and seven patients who died suddenly due to
ventricular tachyarrhythmias. Twelve patients remain on long-term
lorcainide. The actuarial 1-year chance of being
arrhythmia free was 38.9%, and 1-year cardiovascular and
arrhythmia survival rates were 56.8% and 60.4%, respectively. Based on our data we conclude that: In this extremely
drug-resistant patient population the clinical efficacy of
lorcainide is low;
lorcainide should not be used empirically in such highly
drug-resistant patients; persistent
ventricular tachyarrhythmia inducibility at electrophysiologic study implies a poor prognosis in patients treated with oral
lorcainide; the incidence of becoming noninducible during oral
lorcainide therapy in highly
drug-resistant patients appears low; and for patients in whom the
drug seems partially beneficial it could be used in conjunction with a backup automatic
implantable cardioverter/defibrillator.