Effectiveness of Bretylium Tosylate against Refractory Ventricular Arrhythmias

Thirty patients with ventricular tachyarrhythmias, which had not responded to intensive therapy with up to five antiarrhythmic drugs, were treated with bretylium tosylate. All patients had recurrent ventricular tachycardia, and 12 had repeated episodes of ventricular fibrillation. In 17 patients the arrhythmias followed acute myocardial infarction. Bretylium was administered intramuscularly or intravenously, and most patients received 4-5 mg/kg every 6 hours. Eighteen patients responded satisfactorily to bretylium and suffered no further ventricular tachyarrhythmias while receiving the drug. Bretylium partially suppressed ventricular arrhythmic activity in five patients and had no beneficial effects in seven patients. Administration of bretylium soon after the development of arrhythmias and withholding of other antiarrhythmic drugs during bretylium therapy favored a good antiarrhythmic response. Hypotension followed bretylium administration in 19 patients but exceeded 20 mm Hg in only one patient. Transient initial increases in blood pressure and ventricular arrhythmic activity occurred in five and four patients, respectively. Six patients were discharged from the hospital on oral bretylium 600 mg every 6 hours, and all have remained free from major ventricular arrhythmias for up to 15 months. In these patients postural hypotension was a transient and parotid pain a persistent side effect.