(Circulation. 1995;92:3255-3263.)
© 1995 American Heart Association, Inc.
Articles |
Randomized, Double-Blind Comparison of Intravenous Amiodarone and Bretylium in the Treatment of Patients With Recurrent, Hemodynamically Destabilizing Ventricular Tachycardia or Fibrillation
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 8-11, 1993.
Correspondence to Peter R. Kowey, MD, Lankenau Hospital and Medical Research Center, Medical Office Building East, Suite 556, 100 Lancaster Ave West of City Line, Wynnewood, PA 19096.
Background After several days of loading, oral amiodarone, a class III antiarrhythmic, is highly effective in controlling ventricular tachyarrhythmias; however, the delay in onset of activity is not acceptable in patients with immediately life-threatening arrhythmias. Therefore, an intravenous form of therapy is advantageous. This study was designed to compare the safety and efficacy of a high and a low dose of intravenous amiodarone with bretylium, the only approved class III antiarrhythmic agent.
Methods and Results A total of 302 patients with refractory, hemodynamically destabilizing ventricular tachycardia or ventricular fibrillation were enrolled in this double-blind trial at 82 medical centers in the United States. They were randomly assigned to therapy with intravenous bretylium (4.7 g) or intravenous amiodarone administered in a high dose (1.8 g) or a low dose (0.2 g). The primary analysis, arrhythmia event rate during the first 48 hours of therapy, showed comparable efficacy between the bretylium group and the high-dose (1000 mg/24 h) amiodarone group that was greater than that of the low-dose (125 mg/24 h) amiodarone group. Similar results were obtained in the secondary analyses of time to first event and the proportion of patients requiring supplemental infusions. Overall mortality in the 48-hour double-blind period was 13.6% and was not significantly different among the three treatment groups. Significantly more patients treated with bretylium had hypotension compared with the two amiodarone groups. More patients remained on the 1000-mg amiodarone regimen than on the other regimens.
Conclusions Bretylium and amiodarone appear to have comparable efficacies for the treatment of highly malignant ventricular arrhythmias. Bretylium use, however, may be limited by a high incidence of hypotension.
Key Words: amiodarone • bretylium • ventricles • fibrillation • tachycardia
This article has been cited by other articles:
 |
|
 |
|
  American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery J. Am. Coll. Cardiol., November 24, 2009; 54(22): e13 - e118. [Full Text] [PDF]
|
|
|
|
 |
|
 2007 WRITING COMMITTEE MEMBERS, L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, November 24, 2009; 120(21): e169 - e276. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Schmitt, G. Duray, B. J. Gersh, and S. H. Hohnloser Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications Eur. Heart J., May 1, 2009; 30(9): 1038 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Cushing, M. P. Adams, W. D. Cooper, P. R. Kowey, and R. J. Lipicky Bioequivalence of 2 Intravenous Amiodarone Formulations in Healthy Participants J. Clin. Pharmacol., April 1, 2009; 49(4): 407 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Corbett and J. A. Rebuck Medication-Related Complications in the Trauma Patient J Intensive Care Med, March 1, 2008; 23(2): 91 - 108. [Abstract] [PDF]
|
|
|
|
 |
|
 D R Tomlinson, P Cherian, T R Betts, and Y Bashir Intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained ventricular tachycardia: is bolus dose amiodarone an appropriate first-line treatment? Emerg. Med. J., January 1, 2008; 25(1): 15 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Levy, K. A. Tanaka, and J. M. Bailey Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2008; 3(2008): 77 - 110. [Full Text]
|
|
|
|
|
|
M. P. Anstadt and J. E. Lowe Cardiopulmonary Resuscitation Card. Surg. Adult, January 1, 2008; 3(2008): 487 - 506. [Full Text]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]
|
|
|
|
 |
|
 The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Brigadeau, C. Kouakam, D. Klug, C. Marquie, A. Duhamel, F. Mizon-Gerard, D. Lacroix, and S. Kacet Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators Eur. Heart J., March 2, 2006; 27(6): 700 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 6: Pediatric Basic and Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-73 - III-90. [Full Text] [PDF]
|
|
|
|
|
|
W. Whang, C. M. Albert, S. F. Sears Jr, R. Lampert, J. B. Conti, P. J. Wang, J. P. Singh, J. N. Ruskin, J. E. Muller, M. A. Mittleman, et al. Depression as a predictor for appropriate shocks among patients with implantable cardioverter-defibrillators: Results from the Triggers of Ventricular Arrhythmias (TOVA) study J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1090 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Gatzoulis, G. K. Andrikopoulos, T. Apostolopoulos, E. Sotiropoulos, G. Zervopoulos, J. Antoniou, S. Brili, and C. I. Stefanadis Electrical storm is an independent predictor of adverse long-term outcome in the era of implantable defibrillator therapy Europace, January 1, 2005; 7(2): 184 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. N. Srivatsa, R. Ebrahimi, A. El-Bialy, and R. Y. Wachsner Electrical Storm: Case Series and Review of Management Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2003; 8(3): 237 - 246. [Abstract] [PDF]
|
|
|
|
 |
|
 A. T. Cheung, S. J. Weiss, J. S. Savino, W. J. Levy, J. G. Augoustides, A. Harrington, and T. J. Gardner Acute circulatory actions of intravenous amiodarone loading in cardiac surgical patients Ann. Thorac. Surg., August 1, 2003; 76(2): 535 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson and K. Soejima Inside or out? Another option for incessant ventricular tachycardia J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2044 - 2045. [Full Text] [PDF]
|
|
|
|
|
|
P K Moulik, M N Attar, E L Rose, and A A Khaleeli Successful resuscitation of a patient with electrical storm Emerg. Med. J., May 1, 2003; 20(3): e4 - 4. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Bailey, K. A. Tanaka, and J. H. Levy Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2003; 2(2003): 85 - 118. [Full Text]
|
|
|
|
|
|
M. P. Anstadt and J. E. Lowe Cardiopulmonary Resuscitation Card. Surg. Adult, January 1, 2003; 2(2003): 471 - 494. [Full Text]
|
|
|
|
|
|
B. N. Singh Antiarrhythmic Drugs in Cardiac Arrest Resuscitation: Intravenous Amiodarone or Intravenous Lidocaine? Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2002; 7(2): 61 - 64. [PDF]
|
|
|
|
 |
|
 P. Dorian, D. Cass, B. Schwartz, R. Cooper, R. Gelaznikas, and A. Barr Amiodarone as Compared with Lidocaine for Shock-Resistant Ventricular Fibrillation N. Engl. J. Med., March 21, 2002; 346(12): 884 - 890. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. N. Singh and J. S. M. Sarma Mechanisms of Action of Antiarrhythmic Drugs Relative to the Origin and Perpetuation of Cardiac Arrhythmias Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2001; 6(1): 69 - 87. [PDF]
|
|
|
|
 |
|
 R. HOFMANN, G. WIMMER, and F. LEISCH Intravenous amiodarone bolus immediately controls heart rate in patients with atrial fibrillation accompanied by severe congestive heart failure Heart, December 1, 2000; 84(6): 635 - 635. [Full Text]
|
|
|
|
|
|
K. Nademanee, R. Taylor, W. E. Bailey, D. E. Rieders, and E. M. Kosar Treating Electrical Storm : Sympathetic Blockade Versus Advanced Cardiac Life Support-Guided Therapy Circulation, August 15, 2000; 102(7): 742 - 747. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Goldschlager, A. E. Epstein, G. Naccarelli, B. Olshansky, B. Singh, and for the Practice Guidelines Subcommittee, North Am Practical Guidelines for Clinicians Who Treat Patients With Amiodarone Arch Intern Med, June 26, 2000; 160(12): 1741 - 1748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. N. Singh Initial Antiarrhythmic Drug Therapy During Resuscitation from Sudden Cardiac Death: A Time for a Fundamental Change in Strategy? Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 2000; 5(1): 3 - 9. [PDF]
|
|
|
|
|
|
P. Kulakowski, S. Karczmarewicz, G. Karpinski, M. Soszynska, and L. CeremuzYnski Effects of intravenous amiodarone on ventricular refractoriness, intraventricular conduction, and ventricular tachycardia induction Europace, January 1, 2000; 2(3): 207 - 215. [Abstract] [PDF]
|
|
|
|
|
|
M. Greene, D. Newman, M. Geist, M. Paquette, D. Heng, and P. Dorian Is electrical storm in ICD patients the sign of a dying heart?: Outcome of patients with clusters of ventricular tachyarrhythmias Europace, January 1, 2000; 2(3): 263 - 269. [Abstract] [PDF]
|
|
|
|
|
|
S. J. Connolly Evidence-Based Analysis of Amiodarone Efficacy and Safety Circulation, November 9, 1999; 100(19): 2025 - 2034. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Kudenchuk, L. A. Cobb, M. K. Copass, R. O. Cummins, A. M. Doherty, C. E. Fahrenbruch, A. P. Hallstrom, W. A. Murray, M. Olsufka, and T. Walsh Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation N. Engl. J. Med., September 16, 1999; 341(12): 871 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Ramsay Cardiac Management in the ICU Chest, May 1, 1999; 115 (2009): 138S - 144S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Reiffel Intravenous Amiodarone in the Management of Atrial Fibrillation Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1999; 4(4): 199 - 204. [Abstract] [PDF]
|
|
|
|
|
|
S. C. Credner, T. Klingenheben, O. Mauss, C. Sticherling, and S. H. Hohnloser Electrical storm in patients with transvenous implantable cardioverter-defibrillators: Incidence, management and prognostic implications J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1909 - 1915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. N. Singh Amiodarone and Homogeneity of Ventricular Repolarization and Refractoriness Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 1996; 1(4): 265 - 270. [PDF]
|
|
|
|
|
|
J. Altamirano, D. M. Gallik, and B. N. Singh Controlling Paroxysmal Atrial Fibrillation by a Combination of Amiodarone and Flecainide: Description of a Case With 15-Year Follow-up Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 1996; 1(4): 333 - 338. [Abstract] [PDF]
|
|
|
|
|
|
B. S. Stambler, M. A. Wood, K. A. Ellenbogen, K. T. Perry, L. K. Wakefield, and J. T. VanderLugt Efficacy and Safety of Repeated Intravenous Doses of Ibutilide for Rapid Conversion of Atrial Flutter or Fibrillation Circulation, October 1, 1996; 94(7): 1613 - 1621. [Abstract] [Full Text]
|
|
|
|
 |
|
 IV Amiodarone Performs Well Against Bretylium Journal Watch Cardiology, January 1, 1996; 1996(101): 10 - 10. [Full Text]
|
|
|
|
|
|
G. V. Naccarelli and S. Jalal Intravenous Amiodarone : Another Option in the Acute Management of Sustained Ventricular Tachyarrhythmias Circulation, December 1, 1995; 92(11): 3154 - 3155. [Full Text]
|
|
|
|
 |
|
 A. Garfinkel, Y.-H. Kim, O. Voroshilovsky, Z. Qu, J. R. Kil, M.-H. Lee, H. S. Karagueuzian, J. N. Weiss, and P.-S. Chen From the Cover: Preventing ventricular fibrillation by flattening cardiac restitution PNAS, May 23, 2000; 97(11): 6061 - 6066. [Abstract] [Full Text] [PDF]
|
|