Response of Resistant Ventricular Tachycardia to Bretylium

Ventricular tachycardias were determined to be of either right-or left-sided origin in 25 patients whose arrhythmias were life-threatening and resistant to lidocaine and other antiarrhythmic drugs. All five patients with right ventricular tachycardia responded well to bretylium and survived. Eleven of 20 patients with left ventricular tachycardia did not do well. Four did not respond to bretylium but survived, five had no response and died, and two responded but died when hypotension prevented continued treatment. Eight of these 11 had acute anterior myocardial infarction or ischemia. Of nine patients with left ventricular tachycardia who responded well to bretylium and survived, only two had anterior infarction, and none had anterior ischemia. Because bretylium was efficacious in all patients with right ventricular tachycardia or inferior myocardial infarction in this study, it seems warranted to investigate further the relationship between drug responsiveness and the site of ectopic impulse formation and the location of myocardial disease.