Regular paperIntravenous lidocaine versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia☆
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
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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.