Intravenous amiodarone in the acute termination of supraventricular arrhythmias

Treatment of tachyarrhythmias

“…The use of IV procainamide for PSVT (in the presence or absence of an accessory pathway) is supported by 1 study of good quality (LOE 2) showing its comparability with IV amiodarone 61 and results extrapolated from numerous studies (LOE 7) related primarily to its use for conversion of atrial fibrillation or alteration of conduction in accessory pathways. The use of IV amiodarone is supported by at least 8 studies of good quality (LOE 5) specific to AVNRT or accessory pathway-mediated AVRT 45,49,52,55,66,71,73,92 (3 of these studies 66,73,92 were conducted in children), 2 studies (LOE 2) showing comparability with procainamide 61 and magnesium, 136 and 1 study (LOE 2) showing less efficacy than propafenone. 50 The use of IV flecainide for PSVT is supported by evidence from 1 study (LOE 7) demonstrating an effect on slowing or blocking accessory pathway conduction similar to that of propafenone 137 and 1 study (LOE 5) specific to AVNRT or AVRT.…”

“…IV amiodarone was reported to be reasonably effective in 3 studies (LOE 5). 45,52,55 The use of IV propafenone is supported by 1 pediatric study (LOE 5). 142 No experience with use of parenteral bretylium, ibutilide (NAUS), sotalol (NAUS), flecainide (NAUS), or disopyramide (NAUS) in children has been published.…”

Part 6: Advanced Cardiovascular Life Support : Section 5: Pharmacology I: Agents for Arrhythmias

“…Use of IV procainamide for PSVT (in the presence or absence of an accessory pathway) is effective. 69 IV amiodarone is effective in AVNRT or accessory pathway-mediated AVRT 53,57,60,63,79 and is comparable to procainamide 69 and magnesium 126 but has less efficacy than propafenone. 58 IV flecainide 127 and IV sotalol 128,129 have also been useful in terminating PSVT due to AVNRT.…”

“…Therefore, in patients at risk for systemic emboli, amiodarone is recommended only when other medications for rate control have proved ineffective or are contraindicated and the risk of possible pharmacological cardioversion is felt to be justified. Some studies have found that whereas amiodarone was effective for rate control, conversion to sinus rhythm was no greater with conventional doses of IV amiodarone than placebo or digitalis, [55][56][57][58][59][60][61][62][63][64][65][66][67]160 particularly in refractory AF and clinical shock. Because of this concern amiodarone should be reserved for use within the first 48 hours of arrhythmia onset 62,78 or in patients in whom other rate-control measures are ineffective or contraindicated.…”

“…59 Digitalis also has been associated with provoking ectopic atrial tachycardia. Other useful drugs for ectopic atrial tachycardia or MAT include amiodarone, 59,60,80 flecainide, 131,132 and propafenone. 133,134 Quinidine, procainamide, and phenytoin are not effective.…”