Use of intravenous amiodarone for emergency treatment of life-threatening ventricular arrhythmias (original) (raw)
Related papers
Efficacy and safety of intravenous amiodarone in acute refractory arrhythmias
Clinical Cardiology, 1988
Few data are available on intravenous amiodarone therapy in refractory arrhythmias. This retrospective study in 50 patients (14 with supraventricular and 36 with ventricular tachyarrhythmias) revealed a favorable effect of intravenous amiodarone in the treatment of life-threatening arrhythmias with an overall success rate of 76%. In the subgroup of patients with ventricular fibdlation and concomitant severe congestive heart failure success rate was low (25%, 2/8), whereas effectiveness in patients with ventricular tachycardias was high (> 90%) and proved to be independent of left ventricular function. If patients with recurrent ventricular fibrillation were excluded from the analysis, successful treatment with intravenous amiodarone was achieved in 90%, even in those patients with severely compromised myocardium.
Long-term clinical outcome of ventricular tachycardia or fibrillation treated with amiodarone
The American Journal of Cardiology, 1984
The determinants of long-term clinical outcome were studied in 42 patients with recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) who were treated with amiodarone as the sole antiarrhythmic agent. Of the 42 patients, 11 (26 % ) either died suddenly or had recurrent, symptomatic, sustained VT during a mean follow-up period of 10 months (range 0.3 to 45). Of the 19 patients without inducible VTNF during electrophysiologic study while receiving amiodarone, 1 patient died suddenly but no patient had recurrent VTNF. Ten of the 23 patients (43 % ) with persistently inducible arrhythmia have died suddenly or have had recurrent VTNF. Using survival and stepwise logistic re-gression analyses, 2 significant independent predictors of recurrent arrhythmia were identified; persistently inducible VT during electrophysiologic testing in patients receiving amiodarone therapy (p <0.002) and the left ventricular ejection fraction at rest (p <0.05). The predictive accuracy of the response to serial electrophysiologic testing during amiodarone therapy was 67 %, the sensitivity was 56% and the specificity was 91%. Thus, serial electrophysiologic testing is useful for determining the prognosis in patients with inducible VTNF treated with amiodarone.
Europace, 2000
Aims Intravenous amiodarone has recently emerged as an important drug for the acute treatment of ventricular tachyarrhythmias. However, electrophysiological actions and the efficacy of the drug in the suppression of ventricular tachycardia inducibility have not yet been fully established. The present study was designed to address these issues. Methods and Results The study group consisted of 18 patients (all males, mean age 75 14 years), who underwent electrophysiological study due to a history of sustained ventricular tachyarrhythmia or syncope with non-sustained ventricular tachycardia detected on ambulatory ECG monitoring. The effects of 5 mg. kg 1 or 10 mg. kg 1 of intravenous amiodarone on (1) ventricular refractoriness (QTc interval, right ventricular effective refractory period and monophasic action potential duration), (2) intraventricular conduction (paced-QRS and signalaveraged QRS duration), and (3) ventricular tachycardia inducibility, were examined. The drug had no significant effect on ventricular refractoriness. However, a relatively small but significant slowing of intraventricular conduction was seen (paced-QRS duration: 182 27 ms vs 191 28 ms, P<0•0007; 183 32 ms vs 195 33 ms, P<0•0007; and 177 21 ms vs 192 24 ms, P<0•003, at the cycle lengths of 600, 500 and 400 ms, respectively). This effect was more evident during extrasystolic beats than during stable pacing (for example, at the cycle length of 600 ms, the magnitude of amiodarone-induced lengthening of QRS duration was 23•9 17•6 ms vs 9•7 7•2 ms, P<0•009, respectively). Intravenous amiodarone did not prevent induction of sustained ventricular tachycardia in any of five patients inducible at baseline. Of six patients with non-sustained ventricular tachycardia, five had sustained ventricular tachycardia or fibrillation induced after amiodarone infusion. Conclusion Intravenous amiodarone does not prolong ventricular refractoriness, slows intraventricular conduction and may facilitate inducibility of sustained ventricular arrhythmias.