Tomlinson D R, Cherian P, Betts T R, Bashir Y
Department of Cardiac Rhythm Management, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
Emerg Med J. 2008 Jan;25(1):15-8. doi: 10.1136/emj.2007.051086.
To examine the efficacy of bolus dose intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained monomorphic ventricular tachycardia (VT).
DESIGN, SETTING AND PARTICIPANTS: Retrospective case series of consecutive emergency admissions with haemodynamically-tolerated sustained monomorphic VT administered bolus dose intravenous amiodarone 300 mg, according to current UK advanced life support practice guidelines.
Pharmacological termination rates within 20 min and 1 h and incidence of hypotension requiring emergency direct current cardioversion (DCCV) during this period.
41 patients (35 men) of mean (SD) age 68 (10) years, the majority (85%) with ischaemic heart disease and impaired left ventricular function (mean (SD) ejection fraction 0.31 (0.11)), were enrolled in the study. The median VT duration was 70 min (range 15-6000), mean heart rate was 174 (34) bpm and systolic and diastolic blood pressures were 112 (22) and 73 (19) mm Hg, respectively. Pharmacological VT termination occurred within 20 min in 6/41 patients (15%; 95% CI 7% to 29%) and within 1 h in 12/41 patients (29%; 95% CI 18% to 45%). Haemodynamic deterioration requiring emergency DCCV occurred in 7/41 patients (17%; 95% CI 8% to 32%).
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.
探讨静脉推注胺碘酮对血流动力学耐受的持续性单形性室性心动过速（VT）进行药物终止的疗效。
设计、地点和参与者：根据英国当前的高级生命支持实践指南，对连续急诊入院且接受300mg静脉推注胺碘酮治疗的血流动力学耐受的持续性单形性VT患者进行回顾性病例系列研究。
20分钟和1小时内的药物终止率，以及在此期间需要紧急直流电复律（DCCV）的低血压发生率。
41例患者（35例男性），平均（标准差）年龄68（10）岁，大多数（85%）患有缺血性心脏病且左心室功能受损（平均（标准差）射血分数0.31（0.11）），纳入本研究。VT的中位持续时间为70分钟（范围15 - 6000），平均心率为174（34）次/分钟，收缩压和舒张压分别为112（22）和73（19）mmHg。6/41例患者（15%；95%可信区间7%至29%）在20分钟内实现药物性VT终止，12/41例患者（29%；95%可信区间18%至45%）在1小时内实现终止。7/41例患者（17%；95%可信区间8%至32%）出现需要紧急DCCV的血流动力学恶化。
尽管高级生命支持指南提倡使用，但静脉推注胺碘酮对急性终止血流动力学耐受的持续性单形性VT相对无效，且有显著比例的患者出现需要紧急DCCV的血流动力学不稳定。之前在相同临床环境中的研究表明，其他抗心律失常药物，尤其是静脉注射普鲁卡因胺和索他洛尔，可能更具优势。需要进行前瞻性随机试验以确定急诊情况下稳定的持续性单形性VT的最佳药物治疗方案。
