Suppression by propranolol and amiodarone of an electrical storm refractory to metoprolol and amiodarone.
A 60-year-old male patient with ischemic cardiomyopathy experienced an electrical storm 1 month after implantation of an internal cardioverter-defibrillator. Recurrent life-threatening episodes of ventricular tachycardia persisted despite maximal antiarrhythmic theraphy with amiodarone, metoprolol and mexiletine. After a total of more than 500 cardioversions, all antiarrhythmic medications were withdrawn, and the nonselective beta-blocker propranolol was initiated. Electrical stability was achieved and the patient was discharged on propranolol 400 mg/day. Two months later, a second arrhythmia cluster occurred that was controlled by the addition of amiodarone. The patient remains free of arrhythmia 15 months after the event with the combination of propranolol and amiodarone.
Tsagalou
Eleftheria P
EP
Kanakakis
John
J
Rokas
Stylianos
S
Anastasiou-Nana
Maria I
MI
D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004868:Equipment Failure; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D011433:Propranolol / Q000008:administration & dosage*; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D017211:Treatment Failure
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D011433:Propranolol; D008790:Metoprolol; D000638:Amiodarone