TY - JOUR
T1 - Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias
AU - Levine, Joseph H.
AU - Massumi, Ali
AU - Scheinman, Melvin M.
AU - Winkle, Roger A.
AU - Platia, Edward V.
AU - Chilson, Donald A.
AU - Gomes, J. Anthony
AU - Woosley, Raymond L.
N1 - Funding Information:
Results. Of the 273 patients, 110 (40.3% response rate) survived 24 h without another hypotensive ventricular tachyarrhythmic event while being treated with intravenous amiodarone as a single agent (primary end point). A significant difference in the time to Amiodarone is associated with a significant antiarrhythmic effect, even in patients with refractory ventricular arrhythmias (1-5). Because it has a relatively slow onset of action when administered orally, maximal effect is not reached until 2 to 4 weeks after the initiation of therapy despite aggressive oral loading (6). In contrast, intravenous administration has a rapid From the St. Francis Hospital, Roslyn, New York; *Texas Medical Center, St. Luke's Episcopal Hospital, Houston, Texas; tUniversity of California Medical Center, San Francisco and :)Sequoia Hospital, Redwood City, California; §Washington Hospital, Washington, D.C.; IlDeaconess Hospital, Spokane, Washington; 'liThe Mount Sinai Medical Center, New York, New York; and #Georgetown University, Washington, D.C. A list of participating investigators and institutions for the Intravenous Amiodarone Multicenter Trial Group appears in the Appendix. This study was supported by Wyeth-Ayerst Research, Radnor, Pennsylvania.
PY - 1996/1
Y1 - 1996/1
N2 - Objectives. We sought to determine the response rate and safety of intravenous amiodarone in patients with ventricular tachyarrhythmias refractory to standard therapies. Background. Numerous small retrospective reports suggest a response of refractory ventricular tachyarrhythmias to intravenous amiodarone, yet no controlled prospective trials exist. Methods. Two hundred seventy three patients with recurrent hypotensive ventricular tachyarrhythmias refractory to lidocaine, procainamide and bretylium were randomized to receive one of three doses of intravenous amiodarone: 525, 1,050 or 2,100 mg/24 h (mean [±SE] dose 743.7 ± 418.7, 1,175.2 ± 483.7, 1,921.2 ± 688.8 mg, respectively) by continuous infusion over 24 h. Results. Of the 273 patients, 110 (40.3% response rate) survived 24 h without another hypotensive ventricular tachyarrhythmic event while being treated with intravenous amiodarone as a single agent (primary end point). A significant difference in the time to first recurrence of ventricular tachyarrhythmia (post hoc analysis) over the first 12 h was observed when the combined 1,050- and 2,100-mg dose groups were compared with the 525-mg dose group (p = 0.046). The number of supplemental (150 mg) infusions of intravenous amiodarone (given for breakthrough destabilizing tachyarrhythmias) during hours 0 to 6 (prespecified secondary end point) was significantly greater in the 525-mg dose group than in the 2,100 mg dose group (1.09 ± 1.57 vs. 0.51 ± 0.97, p = 0.0043). However, there was no clear dose-response relation observed in this trial with respect to success rates (primary end point), time to first recurrence of tachyarrhythmia (post hoc analysis) or mortality (secondary end point) over 24 h. Conclusions. Intravenous amiodarone is a relatively safe therapy for ventricular tachyarrhythmias refractory to other medications.
AB - Objectives. We sought to determine the response rate and safety of intravenous amiodarone in patients with ventricular tachyarrhythmias refractory to standard therapies. Background. Numerous small retrospective reports suggest a response of refractory ventricular tachyarrhythmias to intravenous amiodarone, yet no controlled prospective trials exist. Methods. Two hundred seventy three patients with recurrent hypotensive ventricular tachyarrhythmias refractory to lidocaine, procainamide and bretylium were randomized to receive one of three doses of intravenous amiodarone: 525, 1,050 or 2,100 mg/24 h (mean [±SE] dose 743.7 ± 418.7, 1,175.2 ± 483.7, 1,921.2 ± 688.8 mg, respectively) by continuous infusion over 24 h. Results. Of the 273 patients, 110 (40.3% response rate) survived 24 h without another hypotensive ventricular tachyarrhythmic event while being treated with intravenous amiodarone as a single agent (primary end point). A significant difference in the time to first recurrence of ventricular tachyarrhythmia (post hoc analysis) over the first 12 h was observed when the combined 1,050- and 2,100-mg dose groups were compared with the 525-mg dose group (p = 0.046). The number of supplemental (150 mg) infusions of intravenous amiodarone (given for breakthrough destabilizing tachyarrhythmias) during hours 0 to 6 (prespecified secondary end point) was significantly greater in the 525-mg dose group than in the 2,100 mg dose group (1.09 ± 1.57 vs. 0.51 ± 0.97, p = 0.0043). However, there was no clear dose-response relation observed in this trial with respect to success rates (primary end point), time to first recurrence of tachyarrhythmia (post hoc analysis) or mortality (secondary end point) over 24 h. Conclusions. Intravenous amiodarone is a relatively safe therapy for ventricular tachyarrhythmias refractory to other medications.
UR - http://www.scopus.com/inward/record.url?scp=0030025539&partnerID=8YFLogxK
U2 - 10.1016/0735-1097(95)00427-0
DO - 10.1016/0735-1097(95)00427-0
M3 - Article
C2 - 8522712
AN - SCOPUS:0030025539
SN - 0735-1097
VL - 27
SP - 67
EP - 75
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -