Effect of Prophylactic Amiodarone Infusion on the Recurrence of Ventricular Arrhythmias in Out-of-Hospital Cardiac Arrest Survivors: A Propensity-Matched Analysis

Abstract

Amiodarone is recommended for shock-refractory ventricular arrhythmia during resuscitation; however, it is unknown whether amiodarone is effective for preventing ventricular arrhythmia recurrence in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). We investigated the effectiveness of prophylactic amiodarone in preventing ventricular arrhythmia recurrence in OHCA survivors. Data of consecutive adult non-traumatic OHCA survivors treated with TTM between 2010 and 2016 were extracted from prospective cardiac arrest registries of four tertiary care hospitals. The prophylactic amiodarone group was matched in a 1:1 ratio by using propensity scores. The primary outcome was ventricular arrhythmia recurrence requiring defibrillation during TTM. Among 295 patients with an initially shockable rhythm and 149 patients with initially non-shockable-turned-shockable rhythm, 124 patients (27.9%) received prophylactic amiodarone infusion. The incidence of ventricular arrhythmia recurrence was 11.26% (50/444). Multivariate analysis showed prophylactic amiodarone therapy to be the independent factor associated with ventricular arrhythmia recurrence (odds ratio 1.95, 95% CI 1.04–3.65, p = 0.04), however, no such association was observed (odds ratio 1.32, 95% CI 0.57–3.04, p = 0.51) after propensity score matching. In this propensity-score-matched study, prophylactic amiodarone infusion had no effect on preventing ventricular arrhythmia recurrence in OHCA survivors with shockable cardiac arrest. Prophylactic amiodarone administration must be considered carefully.

Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients

“…During TTM, prophylactic antiarrhythmic drug infusion may reduce the incidence of shockable re-arrest. However, a previous propensity-matched study did not identify any benefit of prophylactic amiodarone infusion in all kinds of surviving OHCA patients [16]. We hypothesize that prophylactic anti-arrhythmic drug infusion may be helpful to some OHCA patients who are at risk of shockable re-arrest.…”

“…While no significant associations were identified in the multivariate analysis, some patients received continuous amiodarone infusion, which can suppress shockable ventricular arrhythmia. This study was a secondary analysis of another study that compared continuous amiodarone infusion and not using prophylactic amiodarone for recurrent ventricular arrhythmia during TTM [16]. Therefore, we also only analysed patients who had confirmed shockable rhythm during initial CPR and we had not detail data of patients who had no shockable rhythm despite that they might have a shockable re-arrest.…”

Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis

“…This retrospective observational registry-based study was conducted at a 3 tertiary care university-affiliated teaching hospital in Korea. The data of 949 consecutive adult (≥18 years) patients with non-traumatic OHCA treated with TTM between January 2010 and December 2019 were extracted from prospectively collected OHCA registry data [ 15 , 16 , 17 , 18 ]. The number of patients from each hospital is as follows: 328, 360, and 261, respectively.…”