Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1987 Dec;14(4):382–388.

Electrophysiologic Testing: Predictive of Amiodarone Efficacy in Recurrent Sustained Ventricular Tachycardia?

Ildefonso J Mas 1, Ali Massumi 1, Mary Harlan 1, John J Seger 1, Robert J Hall 1
PMCID: PMC324762  PMID: 15227294

Abstract

The role of programmed ventricular stimulation (PVS) was evaluated in 12 patients with recurrent sustained ventricular tachycardia (VT) who were treated with amiodarone as the sole antiarrhythmic agent. At control PVS, sustained VT was induced in 11 patients and nonsustained VT was induced in one patient, as compared with late PVS (mean, 8.6 weeks) when sustained VT was induced in six patients and nonsustained VT was induced in five. Amiodarone significantly prolonged the patients' RR, PR, QRS, and QTc intervals, VT cycle length, and right ventricular effective refractory period. During a mean follow-up of 16 ± 13.6 months, two patients had recurrent clinical VT. In the patients in whom amiodarone therapy failed (1) sustained VT was induced during late PVS, (2) VT cycle length and symptoms during late PVS and during recurrent clinical VT were similar, and (3) the QTc failed to be prolonged significantly (32.5 ± 1.6 ms in amiodarone failure vs. 84.1 ± 27.1 ms in amiodarone success, P<0.05).

It is concluded that (1) amiodarone in high-risk patients is clinically effective (88.3%), (2) patients with noninducible VT or nonsustained VT during late PVS did not have recurrent clinical VT, (3) late PVS is probably predictive of electrophysiologic and hemodynamic consequences in patients with recurrent spontaneous VT, and (4) failure of the QTc interval to be prolonged substantially is probably predictive of clinical recurrence of VT. (Texas Heart Institute Journal 1987; 14:382-388)

Keywords: Amiodarone

Keywords: anti-arrhythmic agents

Keywords: cardiac pacing, artificial

Keywords: electrocardiography

Keywords: electrophysiology

Keywords: monitoring, physiologic

Keywords: programmed ventricular stimulation

Keywords: ventricular tachycardia

Full text

PDF
382

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbieri E., Conti F., Zampieri P., Trevi G. P., Zardini P., d'Aranno V., Latini R. Amiodarone and desethylamiodarone distribution in the atrium and adipose tissue of patients undergoing short- and long-term treatment with amiodarone. J Am Coll Cardiol. 1986 Jul;8(1):210–213. doi: 10.1016/s0735-1097(86)80114-0. [DOI] [PubMed] [Google Scholar]
  2. Greene H. L., Graham E. L., Werner J. A., Sears G. K., Gross B. W., Gorham J. P., Kudenchuk P. J., Trobaugh G. B. Toxic and therapeutic effects of amiodarone in the treatment of cardiac arrhythmias. J Am Coll Cardiol. 1983 Dec;2(6):1114–1128. doi: 10.1016/s0735-1097(83)80338-6. [DOI] [PubMed] [Google Scholar]
  3. Hamer A. W., Finerman W. B., Jr, Peter T., Mandel W. J. Disparity between the clinical and electrophysiologic effects of amiodarone in the treatment of recurrent ventricular tachyarrhythmias. Am Heart J. 1981 Dec;102(6 Pt 1):992–1000. doi: 10.1016/0002-8703(81)90482-8. [DOI] [PubMed] [Google Scholar]
  4. Hariman R. J., Gomes J. A., Kang P. S., El-Sherif N. Effects of intravenous amiodarone in patients with inducible repetitive ventricular responses and ventricular tachycardia. Am Heart J. 1984 Jun;107(6):1109–1117. doi: 10.1016/0002-8703(84)90265-5. [DOI] [PubMed] [Google Scholar]
  5. Heger J. J., Prystowsky E. N., Jackman W. M., Naccarelli G. V., Warfel K. A., Rinkenberger R. L., Zipes D. P. Clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation. N Engl J Med. 1981 Sep 3;305(10):539–545. doi: 10.1056/NEJM198109033051002. [DOI] [PubMed] [Google Scholar]
  6. Heger J. J., Prystowsky E. N., Zipes D. P. Clinical efficacy of amiodarone in treatment of recurrent ventricular tachycardia and ventricular fibrillation. Am Heart J. 1983 Oct;106(4 Pt 2):887–894. doi: 10.1016/0002-8703(83)90012-1. [DOI] [PubMed] [Google Scholar]
  7. Horowitz L. N., Greenspan A. M., Spielman S. R., Webb C. R., Morganroth J., Rotmensch H., Sokoloff N. M., Rae A. P., Segal B. L., Kay H. R. Usefulness of electrophysiologic testing in evaluation of amiodarone therapy for sustained ventricular tachyarrhythmias associated with coronary heart disease. Am J Cardiol. 1985 Feb 1;55(4):367–371. doi: 10.1016/0002-9149(85)90377-7. [DOI] [PubMed] [Google Scholar]
  8. Horowitz L. N., Spielman S. R., Greenspan A. M., Webb C. R., Kay H. R. Ventricular arrhythmias: use of electrophysiologic studies. Am Heart J. 1983 Oct;106(4 Pt 2):881–886. doi: 10.1016/0002-8703(83)90011-x. [DOI] [PubMed] [Google Scholar]
  9. Kaski J. C., Girotti L. A., Messuti H., Rutitzky B., Rosenbaum M. B. Long-term management of sustained, recurrent, symptomatic ventricular tachycardia with amiodarone. Circulation. 1981 Aug;64(2):273–279. doi: 10.1161/01.cir.64.2.273. [DOI] [PubMed] [Google Scholar]
  10. McComb J. M., Logan K. R., Khan M. M., Geddes J. S., Adgey A. A. Amiodarone-induced ventricular fibrillation. Eur J Cardiol. 1980;11(5):381–385. [PubMed] [Google Scholar]
  11. McGovern B., Garan H., Malacoff R. F., DiMarco J. P., Grant G., Sellers T. D., Ruskin J. N. Long-term clinical outcome of ventricular tachycardia or fibrillation treated with amiodarone. Am J Cardiol. 1984 Jun 1;53(11):1558–1563. doi: 10.1016/0002-9149(84)90579-4. [DOI] [PubMed] [Google Scholar]
  12. Naccarelli G. V., Fineberg N. S., Zipes D. P., Heger J. J., Duncan G., Prystowsky E. N. Amiodarone: risk factors for recurrence of symptomatic ventricular tachycardia identified at electrophysiologic study. J Am Coll Cardiol. 1985 Oct;6(4):814–821. doi: 10.1016/s0735-1097(85)80488-5. [DOI] [PubMed] [Google Scholar]
  13. Nademanee K., Hendrickson J., Kannan R., Singh B. N. Antiarrhythmic efficacy and electrophysiologic actions of amiodarone in patients with life-threatening ventricular arrhythmias: potent suppression of spontaneously occurring tachyarrhythmias versus inconsistent abolition of induced ventricular tachycardia. Am Heart J. 1982 Jun;103(6):950–959. doi: 10.1016/0002-8703(82)90556-7. [DOI] [PubMed] [Google Scholar]
  14. Podrid P. J., Lown B. Amiodarone therapy in symptomatic, sustained refractory atrial and ventricular tachyarrhythmias. Am Heart J. 1981 Apr;101(4):374–379. doi: 10.1016/0002-8703(81)90124-1. [DOI] [PubMed] [Google Scholar]
  15. Pritchard D. A., Singh B. N., Hurley P. J. Effects of amiodarone on thyroid function in patients with ischaemic heart disease. Br Heart J. 1975 Aug;37(8):856–860. doi: 10.1136/hrt.37.8.856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Raeder E. A., Podrid P. J., Lown B. Side effects and complications of amiodarone therapy. Am Heart J. 1985 May;109(5 Pt 1):975–983. doi: 10.1016/0002-8703(85)90238-8. [DOI] [PubMed] [Google Scholar]
  17. Roden D. M., Woosley R. L. QT prolongation and arrhythmia suppression. Am Heart J. 1985 Feb;109(2):411–415. doi: 10.1016/0002-8703(85)90627-1. [DOI] [PubMed] [Google Scholar]
  18. Rosenbaum M. B., Chiale P. A., Halpern M. S., Nau G. J., Przybylski J., Levi R. J., Lázzari J. O., Elizari M. V. Clinical efficacy of amiodarone as an antiarrhythmic agent. Am J Cardiol. 1976 Dec;38(7):934–944. doi: 10.1016/0002-9149(76)90807-9. [DOI] [PubMed] [Google Scholar]
  19. Shenasa M., Denker S., Mahmud R., Lehmann M., Estrada A., Akhtar M. Effect of amiodarone on conduction and refractoriness of the His-Purkinje system in the human heart. J Am Coll Cardiol. 1984 Jul;4(1):105–110. doi: 10.1016/s0735-1097(84)80326-5. [DOI] [PubMed] [Google Scholar]
  20. Singh B. N., Jewitt D. E., Downey J. M., Kirk E. S., Sonnenblick E. H. Effects of amiodarone and L8040, novel antianginal and antiarrhythmic drugs, on cardiac and coronary haemodynamics and on cardiac intracellular potentials. Clin Exp Pharmacol Physiol. 1976 Sep-Oct;3(5):427–442. doi: 10.1111/j.1440-1681.1976.tb00620.x. [DOI] [PubMed] [Google Scholar]
  21. Torres V., Tepper D., Flowers D., Wynn J., Lam S., Keefe D., Miura D. S., Somberg J. C. QT prolongation and the antiarrhythmic efficacy of amiodarone. J Am Coll Cardiol. 1986 Jan;7(1):142–147. doi: 10.1016/s0735-1097(86)80272-8. [DOI] [PubMed] [Google Scholar]
  22. Veltri E. P., Reid P. R., Platia E. V., Griffith L. S. Results of late programmed electrical stimulation and long-term electrophysiologic effects of amiodarone therapy in patients with refractory ventricular tachycardia. Am J Cardiol. 1985 Feb 1;55(4):375–379. doi: 10.1016/0002-9149(85)90379-0. [DOI] [PubMed] [Google Scholar]
  23. Waxman H. L., Groh W. C., Marchlinski F. E., Buxton A. E., Sadowski L. M., Horowitz L. N., Josephson M. E., Kastor J. A. Amiodarone for control of sustained ventricular tachyarrhythmia: clinical and electrophysiologic effects in 51 patients. Am J Cardiol. 1982 Nov;50(5):1066–1074. doi: 10.1016/0002-9149(82)90419-2. [DOI] [PubMed] [Google Scholar]
  24. Zipes D. P., Prystowsky E. N., Heger J. J. Amiodarone: electrophysiologic actions, pharmacokinetics and clinical effects. J Am Coll Cardiol. 1984 Apr;3(4):1059–1071. doi: 10.1016/s0735-1097(84)80367-8. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES