Abstract
Recent studies indicate that oral administration of mexiletine is useful in the therapy of recurrent ventricular tachycardia (VT). To further define the clinical usefulness of this drug, mexiletine was administered to 13 men and 4 women with a mean age ± standard deviation of 62 ± 8 years who had drug-refractory paroxysmal sustained VT associated with chronic ischemic heart disease in 14, valvular heart disease in 1, and primary myocardial disease in 1. One patient had no heart disease. All 17 patients had inducible sustained VT during the control electrophysiologic study and during serial electrophysiologic study on conventional drugs. Eleven patients tolerated a mean maximal daily dose of 1,073 ± 149 mg of mexiletine and underwent programmed ventricular stimulation; sustained VT was inducible in 10 patients and nonsustained VT in 1. in 10 patients with inducible sustained VT on mexiletine, the VT cycle length was longer during mexiletine therapy than during control (mean ± standard error of the mean, 342 ± 22 versus 268 ± 14 ms, respectively) (p < 0.005). Programmed stimulation was not possible in 1 patient with severe neurologic side effects and in 5 patients with mexiletine-related worsening of ventricular arrhythmia. Seven other patients had severe neurologic or gastrointestinal side effects, necessitating dose reduction in 5. This 47 % incidence of noncardiovascular side effects is similar to that in previous reports, but the 29 % incidence of arrhythmia potentiation by mexiletine is unexpectedly higher. Limited follow-up reveals recurrence of VT in 3 of 4 patients treated with oral mexiletine on a long-term basis. In conclusion, oral mexiletine does not appear useful in the therapy of patients with drug-refractory, paroxysmal sustained VT. In addition, its use is associated with a high incidence of adverse effects, cardiovascular (arrhythmic) and noncardiovascular, some of which can be serious and life-threatening.
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