Procaidamine side effects when treating atrial fibrillation

Sinus rythm is great, but at what cost? According to the literature supplied with Procanbid, long term use of the drug can produce (1) a positive ANA titer, (2) hematologigal disorders (leukopenia, agranulocytosis), (3) lupus erythematosus.

1.) How often has procainamide been prescribed (i. e. 20, 100 or 1000 patients) at CHHC and what percentage of patients show side effects 1, 2, 3 listed above?

2.)What is 'long term' use (weeks, years, decades)?

3.)How often should appropriate blood tests be done and are base line blood tests required?

4.)Should the effectivenes of other drugs be seriously considered before using procainamide?

5.)Is there a logical decision tree commonly used in selecting drugs for treating atrial fibrillation or is it strictly trial and error?

Thanks for the advice.

P. S. If there are any procainamide users with good advice out there, please e-mail me at ***@****

[CCF CARDIO MD - DLB]

We have prescribed procainamide to thousands of patients, as has any large medical center. Usually, we like to limit its use to a few weeks if possible. Side effects can become manifest in days, weeks, or months. The positive ANA is common, and not of concern in and of itself. It should not be checked routinely, as it will likely be abnormal. The hematological side effects are rare, the lupus type side effects, such as arthritis, are more common. Gastrointestinal side effects, such as diarrhea, can also occur. There are some patients in whom we use it long term. Unfortunately, all the anti-arrhythmic drugs have side effects that are common and potentially serious. Which drug will work best in an individual is largely a matter of trial and error. Electrical cardioversion can sometimes be combined with drugs to cause reversion to sinus rhythm. It is also not unreasonable in certain circumstances to remain in atrial fibrillation on medications to control the rate and thin the blood.