Intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained ventricular tachycardia: is bolus dose amiodarone an appropriate first-line treatment?

Abstract

Although advocated by advanced life support guidelines, bolus dose intravenous amiodarone was relatively ineffective for acutely terminating haemodynamically-tolerated sustained monomorphic VT with a significant incidence of haemodynamic destabilisation requiring emergency DCCV. Previous studies in the identical clinical setting suggest that alternative antiarrhythmic agents, particularly intravenous procainamide and sotalol, may be superior. A prospective randomised trial is required to determine the optimal drug treatment for stable sustained monomorphic VT in the emergency setting.

Part 8: Adult Advanced Cardiovascular Life Support

“…Amiodarone is also effective in preventing recurrent monomorphic VT or treating refractory ventricular arrhythmias 286,[422][423][424] in patients with coronary artery disease and poor ventricular function. It is given 150 mg IV over 10 minutes; dosing should be repeated as needed to a maximum dose of 2.2 g IV per 24 hours.…”

“…It is given 150 mg IV over 10 minutes; dosing should be repeated as needed to a maximum dose of 2.2 g IV per 24 hours. Higher doses (300 mg) were associated with an increased frequency of hypotension, although some reports 422,424 attributed the hypotension to the vasoactive solvents that are not present in a new form of the drug recently approved for use in the US.…”

Part 8: Advanced Life Support

“…The evidence on the effectiveness of amiodarone (150 to 300 mg) in terminating VT is conflicting with reported conversion rates between 20% to 40% based on 1 controlled trial (LOE 1) 340 and 3 case series (LOE 4) [341][342][343] in patients with coronary artery disease with a low left ventricular ejection fraction in the hospital setting. The use of amiodarone (300 mg) was associated with side effects (primarily hypotension), 341,343 but the effect of these on outcome remains unclear.…”

“…The use of amiodarone (300 mg) was associated with side effects (primarily hypotension), 341,343 but the effect of these on outcome remains unclear.…”

Incessant Monomorphic Ventricular Tachycardia Induced by the Proarrhythmic Effect of Amiodarone

“…As far as we know, this is the first report on monomorphic VT induced after amiodarone infusion. Moreover, the amiodarone efficacy in the treatment of stable VT has not been fully elucidated (8)(9)(10).…”