Author + information
- Received January 20, 1995
- Revision received July 24, 1995
- Accepted August 10, 1995
- Published online January 1, 1996.
- Joseph H. Levine, MD, FACCa,**,
- Ali Massumi, MD, FACC*,
- Melvin M. Scheinman, MD, FACC†,
- Roger A. Winkle, MD, FACC‡,
- Edward V. Platia, MD, FACC§,
- Donald A. Chilson, MD, FACC∥,
- J. Anthony Gomes, MD, FACC¶,
- Raymond L. Woosley, MD, PhD, FACC#,
- for the Intravenous Amiodarone Multicenter Trial Group
- ↵**Address for correspondence: Dr. Joseph H. Levine, Director, Arrhythmia Service, St. Francis Hospital, Heart Center, 100 Port Washington Boulevard, Roslyn, New York 11576.
Objectives. We sought to determine the response rate and safety of intravenous amiodarone in patients with ventricular tachyarrhythmias refractory to standard therapies.
Background. Numerous small retrospective reports suggest a response of refractory ventricular tachyarrhythmias to intravenous amiodarone, yet no controlled prospective trials exist.
Methods. Two hundred seventy-three patients with recurrent hypotensive ventricular tachyarrhythmias refractory to lidocaine, procainamide and bretylium were randomized to receive one of three doses of intravenous amiodarone: 525, 1,050 or 2,100 mg/24 h (mean [±SE] dose 743.7 ± 418.7, 1,175.2 ± 483.7, 1,921.2 ± 688.8 mg, respectively) by continuous infusion over 24 h.
Results. Of the 273 patients, 110 (40.3% response rate) survived 24 h without another hypotensive ventricular tachyarrhythmic event while being treated with intravenous amiodarone as a single agent (primary end point). A significant difference in the time to first recurrence of ventricular tachyarrhythmia (post hoc analysis) over the first 12 h was observed when the combined 1,050- and 2,100-mg dose groups were compared with the 525-mg dose group (p = 0.046). The number of supplemental (150 mg) infusions of intravenous amiodarone (given for breakthrough destabilizing tachyarrhythmias) during hours 0 to 6 (prespecified secondary end point) was significantly greater in the 525-mg dose group than in the 2,100-mg dose group (1.09 ± 1.57 vs. 0.51 ± 0.97, p = 0.0043). However, there was no clear dose-response relation observed in this trial with respect to success rates (primary end point), time to first recurrence of tachyarrhythmia (post hoc analysis) or mortality (secondary end point) over 24 h.
Conclusions. Intravenous amiodarone is a relatively safe therapy for ventricular tachyarrhythmias refractory to other medications.
A list of participating investigators and institution for the Intravenous Amiodarone Multicenter Trial Groups appears in the Appendix. This study was supported by Wyeth-Ayerst Research, Radnor, Pennsylvania.
All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California, San Francisco.
- Received January 20, 1995.
- Revision received July 24, 1995.
- Accepted August 10, 1995.
- American College of Cardiology