title: Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: a systematic review.
abstract: OBJECTIVE
  We performed a systematic review of the literature to compare the efficacy of different drug therapies for the termination of stable, monomorphic ventricular tachycardia (VT).
  
  
  METHODS
  We searched EMBASE, MEDLINE and Cochrane for trials from 1965 through July 2013 using a search strategy derived from the following clinical question in PICO format:
  
  
  METHODS
  Adults (≥18 years) with stable monomorphic VT;
  
  
  METHODS
  Intravenous antidysrhythmic drug; Comparator: Intravenous lidocaine or amiodarone;
  
  
  RESULTS
  Termination of VT. For all drug comparisons, we calculated relative risks (RR; 95% CI) and number needed to treat (NNT, 95% CI) between drugs. We also evaluated the methodological quality of the studies.
  
  
  RESULTS
  Our search yielded 219 articles by PubMed and 390 articles by EMBASE. 3 prospective studies (n=93 patients) and 2 retrospective studies (n=173 patients) met our inclusion and exclusion criteria. From the prospective studies, RR of VT termination of procainamide versus lidocaine was 3.7 (1.3-10.5); ajmaline versus lidocaine, RR=5.3 (1.4-20.5); and sotalol versus lidocaine, RR=3.9 (1.3-11.5). From the retrospective studies: procainamide versus lidocaine, RR=2.2 (1.2-4.0); and procainamide versus amiodarone RR=4.3 (0.8-23.6). All 5 reviewed studies had quality issues, including potential bias for randomisation and concealment.
  
  
  CONCLUSIONS
  Based on limited available evidence from small heterogeneous human studies, for the treatment of stable, monomorphic VT, procainamide, ajmaline and sotalol were all superior to lidocaine; amiodarone was not more effective than procainamide.
authors.affiliation: SUNY Downstate/Kings County Hospital, New York, USA.
authors.forename: Ian S
authors.initials: IS
authors.lastname: deSouza
authors.affiliation: SUNY Downstate/Kings County Hospital, New York, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martindale
authors.affiliation: SUNY Downstate/Kings County Hospital, New York, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Sinert
mesh_terms: D061605:Administration, Intravenous; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000188:drug therapy*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: cardiac care, arrythmia; emergency department management; resuscitation, clinical care