Cardiac arrhythmias (CA) are a frequent and dangerous complication of respiratory and cardiac failure in patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the effects of mexiletine on CA in patients with cor pulmonale in a state of cardio-respiratory decompensation. We studied 32 COPD patients with severe airways obstruction; mean VC 2.3510.53 litres; FEV1, 0.92 ± 0.3 litres and respiratory failure, PaO2 = 56 ± 5 mm Hg, PaCO2 = 47 ± 9 mm Hg allocated by random numbers to 20 treated and 12 controls. Continuous 24-hour Holter monitoring was performed for 3 consecutive days after admission to the department following routine treatment which consisted of low-flow oxygen, antibiotic, bronchodilators and diuretics. On the first day, the type and frequency of CA were analysed. Then the treated patients were given mexiletine 250 mg i.v. + 200 mg orally followed by 200 mg every 8 h for the next 48 h. Controls continued the routine treatment only. Mexiletine treatment resulted in a highly significant reduction in the mean number of premature ventricular beats from 163 to 28 and 30/24 h, respectively (p < 0.01). Episodes of ventricular tachycardia were abolished. The mean number of premature supraventricular beats also fell from 85 to 67 and 48/24h (p < 0.01). Number of episodes of sinus tachycardia fell from 17 during the first day to 13 and 10 on the 2nd and 3rd days, respectively. In the controls, the frequency and type of CA remained unchanged. Our results demonstrate that mexiletine has a beneficial effect in limiting CA in patients with right heart and respiratory failure.

Keywords:
Mexiletine, Cardiac arrhythmias, Cor pulmonale
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© 1989 S. Karger AG, Basel
1989
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