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(Circulation. 1995;92:3154-3155.)
© 1995 American Heart Association, Inc.

Articles

Intravenous Amiodarone

Another Option in the Acute Management of Sustained Ventricular Tachyarrhythmias

Gerald V. Naccarelli, MD; Sohail Jalal, MD

From the Electrophysiology Laboratory, Division of Cardiology, University of Texas Medical School at Houston.

Correspondence to Gerald V. Naccarelli, MD, Division of Cardiology, Pennsylvania State University College of Medicine, M.S. Hershey Medical Center, PO Box 850, 500 University Drive, Hershey, PA 17033.

	Introduction

 
Two timely articles published in this volume of Circulation by Scheinman et al¹ and Kowey et al² present data from recently completed trials confirming the efficacy of intravenous amiodarone in life-threatening ventricular tachyarrhythmias. Intravenous amiodarone has recently received Food and Drug Administration approval for the acute treatment and prevention of ventricular fibrillation (VF) and hemodynamically destabilizing ventricular tachycardia (VT) refractory to other therapy. The above-mentioned two trials were performed in severely ill patients who had life-threatening ventricular arrhythmias not controlled by several other intravenous antiarrhythmics.

The mean age of the patients in these studies was in the 60-year range, 75% of the patients were men, the mean ejection fraction was 31%, 81% had had a prior myocardial infarction, 19% were on ventilator support, and 23% were on balloon pump support. Therefore, these patients were elderly, had severe ischemic structural heart disease and left ventricular dysfunction, and all the patients had hemodynamically destabilizing VT, incessant VT, and/or VF. The poor prognosis of this population limited the study design: (1) it was unethical to consider a placebo control group; (2) supplemental bolus doses were permitted to prevent recurrence of ventricular tachyarrhythmias; (3) open-label therapy was permitted even after double-blind therapy in attempts to save patients from dying; and (4) given the limitations of the enrollment criteria, a large number of centers were required for enrollment.

A prior study³ using doses of 500, 1000, and 2000 mg every 24 hours demonstrated that all of these doses were about equally effective in treating ventricular . . . [Full Text of this Article]

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