High-dosage continuous amiodarone therapy to treat new-onset supraventricular tachyarrhythmias in surgical intensive care patients: an observational study

Abstract

Background: New-onset supraventricular tachyarrhythmias (SVTA) are a complication contributing significantly to morbidity and mortality in surgical intensive care unit (SICU) patients. Although only few data on efficiency can be found in the literature, class III antiarrhythmics have become popular in the treatment of SVTA in critically ill patients.

Setting: 12-bed general and surgical ICU in a university teaching hospital.

Design: Observational, retrospective study.

Patients: 131 SICU patients with SVTA (narrow-complex non-sinus tachyarrhythmias with heart rates > or = 100 bpm).

Intervention: High-dosage amiodarone infusion according to an institutional protocol.

Measurements: Hemodynamic data, acid-base status, and single organ functions were obtained in all patients before amiodarone infusion and at 12, 24, and 48 hours afterwards. Patients were divided into responders and nonresponders. Amiodarone infusion (mean dosage 24 h: 1625+/-528 mg; 48 h: 2708+/-895 mg) restored sinus rhythm in 54% of study patients within 12 h, in 64% within 24 h, and in 75% within 48 h. Heart rate, central venous pressure, and milrinone requirements significantly decreased in all patients; this was accompanied by a significant increase in stroke-volume index and mean arterial pressure. Serum concentrations of creatinine and bilirubin increased in all patients.

Conclusion: High-dosage continuous amiodarone infusion during a period of 48 hours resulted in restoration of SR in 75% of SICU patients with new-onset SVTA and moderate to severe multiple-organ dysfunction syndrome. A significant improvement in cardiocirculatory function was more pronounced in responders but could be demonstrated irrespective of restoration of sinus rhythm in all patients. Apart from a possibly amiodarone-mediated increase in concentrations of creatinine and bilirubin, no major drug-related adverse effects occurred during the observation period.