Regular paper
Intravenous lidocaine versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia

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Abstract

The effectiveness of intravenous amiodarone for the treatment of incessant (shock resistant) ventricular tachycardia (VT) has not been established. This study evaluated the efficacy of a water-soluble amiodarone preparation or lidocaine for the treatment of shock-resistant VT. The trial was a double-blinded parallel design. Patients were randomized to receive up to 2 boluses of either 150 mg intravenous amiodarone or 2 boluses of 100 mg lidocaine followed by a 24-hour infusion. If the first assigned medication failed to terminate VT, the patient was crossed over to the alternative therapy. Twenty-nine patients were randomized to the study (18 received amiodarone and 11 received lidocaine). There were no significant differences between groups withregard to baseline characteristics. Immediate VT termination was achieved in 14 patients (78%) with amiodarone versus 3 patients (27%) on lidocaine (p <0.05). After 1 hour, 12 patients (67%) on amiodarone and 1 patient (9%) on lidocaine were alive and free of VT (p <0.01). Amiodarone had a 33% drug failure rate, whereas there was a 91% drug failure rate for lidocaine. The 24-hour survival was 39% on amiodarone and 9% on lidocaine (p <0.01). Drug-related hypotension with aqueous amiodarone was less frequent than with lidocaine. This study found that amiodarone is more effective than lidocaine in the treatment of shock-resistant VT.

Section snippets

Protocol:

The study was carried out as a double-blinded, parallel-designed trial with the lidocaine-treated group acting as controls. Patients with incessant VT were eligible for the study. Incessant VT was defined as sustained VT refractory to electroshock with a heart rate of >120 beats/min. The exclusion criteria were any of the following: (1) a “do not resuscitate” order, (2) concomitant use of another experimental antiarrhythmic medication, (3) known life-threatening allergy to lidocaine or

Results

This international study was performed in 63 centers from 3 countries (Canada, Hungary, and the United States) over a duration of 4 years. Principal investigators who succeeded with patient enrollment are listed in the Appendix. Due to problems in patient recruitment relating to entry criteria, only 29 patients were entered into the study. Of the 29 patients, 11 received lidocaine and 18 received amiodarone as first-line therapy following electroshock. Patient demographics are listed in Table 1

Discussion

This is the first controlled clinical trial evaluating the effectiveness of amiodarone and lidocaine on shock-resistant VT. The results of this study show that Amio-Aqueous, a water-soluble intravenous amiodarone preparation, is more effective than lidocaine for the termination of shock-resistant VT and in terms of survival.

The Advanced Cardiac Life Support guidelines for the treatment of VT have recently undergone significant changes.19 Bretylium has been removed due to availability questions

References (32)

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This study was sponsored by Academic Pharmaceuticals, Lake Bluff, Illinois.

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A list of principal investigators appears in the Appendix.

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