Pirmenol: An antiarrhythmic drug with unique electrocardiographic features—a double‐blind placebo‐controlled comparison with quinidine

Abstract Previous reports have stated that pirmenol is a Class IA antiarrhythmic drug that prolongs the QT interval, but did not use computerized electrocardiography. We randomized 18 patients with frequent ventricular ectopic depolarizations to pirmenol (8 patients) or quinidine (10 patients). Pirmenol was effective and tolerated for suppression of arrhythmia in all 7 patients treated (1 patient withdrew for personal reasons) but quinidine was effective and tolerated for 4 weeks in only 5 of 10 patients (p<0.05). Using computerized 12‐lead electrocardiography, the mean change in PR interval from placebo to treatment was 5 ± 18 ms for quinidine and 5 ± 11 ms for pirmenol (p = NS). The mean change in QRS interval was 5 ± 14 ms for quinidine and 10 ± 5 ms for pirmenol (p = NS). The mean change in QT interval was 46 ± 30 ms for quinidine and 8 ± 9 ms for pirmenol (p<0.01) and the mean change in JT interval was 41 ± 36 ms for quinidine and –2 ± 10 ms for pirmenol (p<0.01). After the double‐blind phase, 4 quinidine patients had computerized electrocardiographic intervals measured on pirmenol; the above findings were confirmed. These electrocardiographic features of pirmenol clearly distinguish it from quinidine, the prototype Class IA drug. However, pirmenol has minimal effect on the PR and QRS intervals, and thus does not appear to be a Class IC drug either. Although its electrocardiographic features are closest to Class IB, its electrophysiology in isolated cells and its antiarrhythmic and side effect profile are atypical for a IB agent. Pirmenol is a unique antiarrhythmic drug that merits further study. Results of this study suggest that the IA‐IB‐IC antiarrhythmic drug classification may be an over‐simplification.