title: The use of dronedarone for recurrent ventricular tachycardia: a case report and review of the literature.
abstract: BACKGROUND
  Dronedarone is a benzofuran derivative resembling amiodarone that was intended to reduce the iodine-associated tissue deposition and organ toxicity seen with the latter. The utility of dronedarone for patients with ventricular arrhythmias has not been thoroughly evaluated. We present our experience with its use to treat refractory ventricular tachycardia storm and review the literature.
  
  
  METHODS
  An 85 year-old gentleman with multiple medical comorbidities including ischemic and non-ischemic cardiomyopathy with severe biventricular systolic dysfunction presented with ventricular tachycardia storm. Therapeutic options were limited given his frail medical status, failures of sotalol, mexilitine, and catheter ablation therapies along with drug-toxicities from amiodarone. Dronedarone was thus considered as off-label use following informed consent. The patient unfortunately developed fatal multisystem organ failure including acute severe hepatotoxicity from dronedarone.
  
  
  CONCLUSIONS
  Novel therapies for drug-refractory ventricular arrhythmias are long overdue given the limitations of available pharmacologic and non-pharmacologic options. Off-label use of antiarrhythmic agents such as dronedarone is considered a treatment of last-resort in patients who otherwise have no therapeutic options. Given the paucity of reported cases regarding dronedarone for the treatment of ventricular tachyarrhythmias, no conclusive recommendations can be made at this time aside from words of caution. Despite the potential ventricular antiarrhythmic effects of dronedarone, careful patient evaluation is required to identify those at greatest risk of drug-related adverse events particularly in those patients with significant comorbidities such as advanced hepatic, renal, and cardiovascular disease.
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Rizkallah
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kuriachan
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada. Brent.Mitchell@albertahealthservices.ca.|C829 Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada. Brent.Mitchell@albertahealthservices.ca.
authors.forename: L
authors.initials: L
authors.lastname: Brent Mitchell
mesh_terms: D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects / Q000031:analogs & derivatives*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D017115:Catheter Ablation; D000077764:Dronedarone; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology* / Q000473:pathology; D009325:Nausea / Q000209:etiology* / Q000503:physiopathology; D056687:Off-Label Use; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D017211:Treatment Failure
chemical_list: D000889:Anti-Arrhythmia Agents; D000077764:Dronedarone; D000638:Amiodarone
keywords: Adverse drug effect; Arrhythmia; Dronedarone; Drug-refractory; Ventricular tachycardia