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首页> 外文期刊>Emergency medicine journal: EMJ >Intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained ventricular tachycardia: is bolus dose amiodarone an appropriate first-line treatment?
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Intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained ventricular tachycardia: is bolus dose amiodarone an appropriate first-line treatment?

机译：静脉给予胺碘酮可终止血流动力学耐受的持续性室性心动过速的药理作用：剂量胺碘酮是否适合作为一线治疗？

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摘要

OBJECTIVE: 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. MAIN OUTCOME MEASURES: Pharmacological termination rates within 20 min and 1 h and incidence of hypotension requiring emergency direct current cardioversion (DCCV) during this period. RESULTS: 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%). CONCLUSIONS: 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.
机译：目的：观察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）的药理学终止作用。设计，地点和参与者：根据英国现行的高级生命支持实践指南，连续连续病例的回顾性病例系列，包括接受血流动力学耐受的持续单形性VT静脉推注胺碘酮300毫克。主要观察指标：在此期间，在20分钟和1小时内的药理终止率和低血压发生率需要紧急直流电复律（DCCV）。结果：纳入41名平均年龄（SD）为68岁（10岁）的患者（35名男性），其中大多数（85％）患有缺血性心脏病且左心室功能受损（平均（SD）射血分数为0.31（0.11））。在研究中。中位VT持续时间为70分钟（范围为15-6000），平均心率为174（34）bpm，收缩压和舒张压分别为112（22）和73（19）mm Hg。药理性VT终止发生在6/41患者中（20％）（15％; 95％CI 7％至29％）在20分钟内发生（12％/ 95％CI 18％至45％）（12.9％）。需要紧急DCCV的血流动力学恶化发生在7/41患者中（17％; 95％CI 8％至32％）。结论：尽管先进的生命支持指南提倡，静脉推注胺碘酮对急性终止血流动力学耐受的持续单形性室速相对无效，而血流动力学不稳定的发生率很高，需要紧急DCCV。以前在相同临床环境中进行的研究表明，替代性抗心律不齐药物，尤其是静脉注射普鲁卡因胺和索他洛尔可能更好。需要一项前瞻性随机试验来确定在紧急情况下稳定持续单形性室速的最佳药物治疗。

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