Acute management of ventricular arrhythmias: role of antiarrhythmic agents.
When treating life-threatening ventricular arrhythmias such as symptomatic ventricular tachycardia and ventricular fibrillation (VT/VF), the nature of the arrhythmia must be precisely defined and the approach must be tailored to it. For hemodynamically unstable ventricular arrhythmias, DC cardioversion or high-energy defibrillation remains the approach of choice. Determining the specific role of intravenous drugs in acute conversion of VT/VF and the most appropriate long-term therapy (pharmacologic or nonpharmacologic) to prevent recurrence can be difficult. Pharmacologic conversion of stable VT/VF presents an even greater challenge, as the role of lidocaine considered the first-line agent for many decades, is now being reevaluated. Lidocaine appears to be effective in converting no more than 20% of stable VTs, compared with 70% for intravenous sotalol. The precise efficacies of parenteral procainamide, beta-blockers, and newer class III agents, including intravenous amiodarone, remain to be defined; however, intravenous amiodarone, available recently, can control unstable, recurrent VT/VF that is resistant to lidocaine or procainamide. A standard regimen of concomitant intravenous and oral amiodarone may be given for rapid and sustained control, and allows oral amiodarone to be continued in a significant number of patients.
Singh
B N
BN
Cardiology Section, VA Affairs Medical Center, West Los Angeles, CA 90073, USA.
D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000145:classification / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004554:Electric Countershock; D006801:Humans; D017180:Tachycardia, Ventricular / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000517:prevention & control / Q000628:therapy*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone