The Current Status of Diphenylhydantoin in Heart Disease

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Abstract
Excellent results were obtained in 53% of 676 cases of ventricular arrhythmias and 10% of 98 cases of supra-ventricular arrhythmias treated with intravenous diphenylhydantoin (Dilantin). Combining data with previously reported clinical data gave a total of nearly 1000 patients in whom diphenylhydantoin was used for treatment of cardiac arrhythmias. Intravenous administration was: highly efficacious in treating ventricular arrhythmias associated with anesthesia, cardioversion, cardiac catheterization and cardiac surgery, and in treating digitalis-induced atrial tachycardia; moderately effective in treating digitalis-induced ventricular arrhythmias; reasonably effective in treating ventricular but not supraventricular arrhythmias associated with arteriosclerotic heart disease; not very effective in terminating paroxysmal atrial tachycardia; rarely effective in atrial flutter, and never effective in atrial fibrillation. Oral administration was highly efficacious in treating recurrent supraventricular and ventricular arrhythmias. A comprehensive review of the literature concerning diphenylhydantoin and cardiac function revealed that: its antiarrhythmic properties mainly are due to direct myocardial effects which may involve alterations in Na ion distribution and which are different from the effects of procaine amide and quinidine; some of its antiarrhythmic properties may be due to a central nervous system effect; the drug is relatively safe but slow administration of low doses is necessary to avoid significant untoward cardiovascular effects which may include disturbances of rate and rhythm, depression of cardiac performance and hypotension. Diphenylhydantoin is a valuable addition to the acute and chronic treatment of cardiac arrhythmias and that the antiarrhythmic properties of it and other anticonvulsants should be investigated further.