Use of intravenous amiodarone for emergency treatment of life-threatening ventricular arrhythmias.
Efficacy, side effects and predictors of response for intravenous amiodarone were evaluated in 46 patients with recurrent drug-refractory sustained ventricular tachycardia or ventricular fibrillation, or both, who were treated with intravenous amiodarone. Of the 46 patients, 27 (58.5%) responded early to intravenous amiodarone and 6 (13%) showed a late response to amiodarone. The majority of patients who responded to intravenous amiodarone did so within the first 2 h of therapy, and all responded within 84 h. Patients with an ejection fraction greater than 25% were more likely to respond (p less than 0.05). Major side effects occurred in 13% of patients. The cumulative 2 year mortality rate due to arrhythmia recurrence or sudden death for responders discharged from the hospital was 23% and the cumulative overall 2 year mortality rate was 46%. In conclusion, intravenous amiodarone is rapidly effective in the majority of patients with recurrent ventricular tachycardia or ventricular fibrillation refractory to other drugs. The poor long-term outcome of patients who require this therapy, respond to it and are discharged on long-term oral amiodarone therapy warrants consideration of other long-term treatment of these patients. Use of intravenous amiodarone is an important new modality in the treatment of drug-refractory malignant ventricular arrhythmias.
Helmy
I
I
Department of Medicine, University of California, San Francisco 94143-0214.
Herre
J M
JM
Gee
G
G
Sharkey
H
H
Malone
P
P
Sauve
M J
MJ
Griffin
J C
JC
Scheinman
M M
MM
D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000503:physiopathology; D001919:Bradycardia / Q000139:chemically induced / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D004632:Emergency Medical Services; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007275:Injections, Intravenous; D008133:Long QT Syndrome / Q000139:chemically induced; D013318:Stroke Volume; D013617:Tachycardia, Supraventricular / Q000139:chemically induced / Q000145:classification; D013997:Time Factors
D000638:Amiodarone