Intravenous amiodarone is safe and seems to be effective in termination of paroxysmal supraventricular tachyarrhythmias

Abstract

Background: Paroxysmal atrial fibrillation (PAF) and paroxysmal supraventricular tachycardia (PSVT) leading to hemodynamic compromise are among the most common reasons for admission to the coronary care unit (CCU) and need prompt and efficient therapy. Direct current cardioversion is the therapy of choice, but if found contraindicated or unavailable some antiarrhythmie agents are usually given to restore sinus rhythm. Many of these drugs have obvious limitations, especially in patients with acute myocardial infarction and/or heart failure. Hypothesis: The aim of the present study was to assess the safety and efficacy of intravenous amiodarone in the acute termination of PAF or PSVT refractory to other antiarrhythmie agents in a large group of patients consecutively admitted to our CCU. Methods: In the present study, we evaluated the safety and efficacy of amiodarone given intravenously in 142 consecutive patients with PAF or PSVT lasting < 24 h. In 37% of patients no evidence of underlying heart disease which may have caused arrhythmias were defined. A median of two other antiarrhythmic agents given prior to the first amiodarone injection had been ineffective. Results: Sinus rhythm was restored in 91 patients (64%) (65% in the PAF group and 61% in the PSVT group). The mean time to rhythm conversion was 5.5 ± 6.1 h for patients with PAF and 1.2 ± 1.2 h for patients with PSVT. The mean dose of amiodarone administered up to conversion was 340 ± 220 mg for PAF and 220 ± 105 mg for PSVT. Except for transient first‐degree atrioventricular block in two patients, no adverse effects possibly related to amiodarone were observed (including proarrhythmia and incidence or aggravation of heart failure symptoms). Conclusion: Amiodarone given intravenously for acute termination of supraventricular tachyarrhythmias is completely safe and seems effective. The results of this study, which is the largest ever made, indicate a need of randomized, controlled trials for the ultimate assessment of the efficacy of amiodarone in this clinical setting.

Part 8: Adult Advanced Cardiovascular Life Support

“…Although 2 randomized clinical trials 383,386 documented a similar PSVT conversion rate between adenosine and calcium channel blockers, adenosine was more rapid and had fewer severe side effects than verapamil. Amiodarone as well as other antiarrhythmic agents can be useful in the termination of PSVT, but the onset of action of amiodarone is slower than that of adenosine, 399 and the potential proarrhythmic risks of these agents favor the use of safer treatment alternatives.…”

Part 8: Advanced Life Support

“…[272][273][274][275]277,278 The effectiveness of diltiazem in conversion to sinus rhythm is supported by 4 trials (LOE 1). 273,277,279,280 The evidence to support the use of other drugs for conversion to sinus rhythm is limited to a few trials for each drug, including sotalol (LOE 1), 281 amiodarone (LOE 4), 282 propafenone (LOE 1), 283 ) and nadolol (LOE 1). 284 The study on nadolol suggested treatment effect on rate as well.…”

Part 7.3: Management of Symptomatic Bradycardia and Tachycardia

“…Amiodarone can achieve nearly 100% efficacy in the inhibition of induced sustained reentrant SVT (LOE 6). 22 Adenosine is safe and effective in pregnancy. 23 Adenosine, however, does have several important drug interactions.…”