Use of intravenous amiodarone for emergency treatment of life-threatening ventricular arrhythmias

• Published in: Journal of the American College of Cardiology Vol. 12; no. 4; pp. 1015 - 1022
• Main Authors: Helmy, Ibrahim, Herre, John M., Gee, Garwood, Sharkey, Hugh, Malone, Patricia, Sauve, Mary Jane, Griffin, Jerry C., Scheinman, Melvin M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-1988; Elsevier Science
• Subjects: Amiodarone - adverse effects; Amiodarone - therapeutic use; Antiarythmic agents; Arrhythmias, Cardiac - drug therapy; Arrhythmias, Cardiac - physiopathology; Biological and medical sciences; Bradycardia - chemically induced; Bradycardia - therapy; Cardiac Pacing, Artificial; Cardiovascular system; Electrocardiography; Emergency Medical Services; Follow-Up Studies; Hospitalization; Humans; Hypotension - chemically induced; Injections, Intravenous; Long QT Syndrome - chemically induced; Medical sciences; Pharmacology. Drug treatments; Stroke Volume; Tachycardia, Supraventricular - chemically induced; Tachycardia, Supraventricular - classification; Time Factors; Therapeutic efficiency; Human; Chemotherapy; Intravenous administration; Arrhythmia; Cardiovascular disease; Paroxysmal ventricular tachycardia; Antiarrhythmia agent; Resuscitation; Ventricular fibrillation
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(88)90470-6

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 >25% were more likely to respond (p < 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.