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Rapid Suppression of Spontaneous Ventricular Arrhythmias during Oral Amiodarone Loading

Soo G. Kim, MD; Michael M. Mannino, MD; Robert Chou, MD; Scott Roth, MD; James A. Roth, MD; Basavaraj Desai, MD; Kevin J. Ferrick, MD; and John D. Fisher, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Soo G. Kim, MD, Division of Cardiology, Montefiore Medical Center, 111 East 210 th Street, Bronx, NY 10467.

Current Authors Addresses: Drs. Kim, Mannino, J. A. Roth, Desai, Ferrick, and Fisher: Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467.

Dr. S. Roth: Division of Cardiology, Long Island Jewish Medical Center, 270-05 76th Avenue, Room 2135, New Hyde Park, NY 11042.

Dr. Chou: Department of Medicine, Columbia-Presbyterian Medical Center, 622 West 168th Street, Box P.H. 62, New York, NY 10032.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;117(3):197-201. doi:10.7326/0003-4819-117-3-197
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Objective: To determine the time course of effects of amiodarone during an oral loading period.

Design: A prospective, nonrandomized study.

Setting: Arrhythmia referral center at a university hospital.

Patients: Fifty patients with refractory sustained ventricular tachycardia (n = 44) or ventricular fibrillation (n = 6) and frequent (≥ 30/h) ventricular premature complexes.

Intervention: Oral amiodarone, 1200 mg/d for 14 days and 400 mg/d thereafter.

Measurements: Ambulatory electrocardiographic monitorings, 12-lead electrocardiograms, and amiodarone blood levels on days 3, 5, 7, 9, 11, 13, and 28.

Results: Dramatic reductions of ventricular arrhythmias were noted during the first 72 hours of the therapy. Average ventricular premature complexes/h, couplets/h, and nonsustained ventricular tachycardias/24 h were 524 ± 1224/h, 16 ± 61/h, and 167 ± 611/24 h, respectively, at baseline, and reduced to 140 ± 243/h, 11 ± 50/h, and 33 ± 117/24 h, respectively, on day 3 (P < 0.05 for all). Subsequent reductions of ventricular arrhythmias from day 3 to day 13 were more gradual but were still significant (P < 0.05). A significant reduction of ventricular arrhythmias (≥ 70% reduction of ventricular premature complexes and ≥ 90% reduction of nonsustained ventricular tachycardias) was noted in 50% of patients on day 3, in 65% on day 7, and in 83% on day 13. Prolongation of the QT interval exhibited a similar time course. There were no further differences in reduction of ventricular premature complexes or QT intervals between day 13 and day 28.

Conclusions: Oral amiodarone given in loading doses produces rapid and dramatic reductions in spontaneous ventricular arrhythmias within 72 hours. Subsequent reductions of spontaneous arrhythmia were gradual and less dramatic.





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