Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2011 Jan;39(1):78-83.
doi: 10.1097/CCM.0b013e3181fd6ad7.

Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction

Jonathan P Piccini  1 , Phillip J Schulte, Karen S Pieper, Rajendra H Mehta, Harvey D White, Frans Van de Werf, Diego Ardissino, Robert M Califf, Christopher B Granger, E Magnus Ohman, John H Alexander
Affiliations
Comparative Study

Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction

Jonathan P Piccini et al. Crit Care Med. 2011 Jan.

Abstract

Objective: Few data exist to guide antiarrhythmic drug therapy for sustained ventricular tachycardia/ventricular fibrillation after acute myocardial infarction. The objective of this analysis was to describe the survival of patients with sustained ventricular tachycardia/ventricular fibrillation after myocardial infarction according to antiarrhythmic drug treatment.

Design and setting: We conducted a retrospective analysis of ST-segment elevation myocardial infarction patients with sustained ventricular tachycardia/ventricular fibrillation in Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO) IIB and GUSTO III and compared all-cause death in patients receiving amiodarone, lidocaine, or no antiarrhythmic. We used Cox proportional-hazards modeling and inverse weighted estimators to adjust for baseline characteristics, β-blocker use, and propensity to receive antiarrhythmics. Due to nonproportional hazards for death in early follow-up (0-3 hrs after sustained ventricular tachycardia/ventricular fibrillation) compared with later follow-up (>3 hrs), we analyzed all-cause mortality using time-specific hazards.

Patients and interventions: Among 19,190 acute myocardial infarction patients, 1,126 (5.9%) developed sustained ventricular tachycardia/ventricular fibrillation and met the inclusion criteria. Patients received lidocaine (n = 664, 59.0%), amiodarone (n = 50, 4.4%), both (n = 110, 9.8%), or no antiarrhythmic (n = 302, 26.8%).

Results: In the first 3 hrs after ventricular tachycardia/ventricular fibrillation, amiodarone (adjusted hazard ratio 0.39, 95% confidence interval 0.21-0.71) and lidocaine (adjusted hazard ratio 0.72, 95% confidence interval 0.53-0.96) were associated with a lower hazard of death-likely evidence of survivor bias. Among patients who survived 3 hrs, amiodarone was associated with increased mortality at 30 days (adjusted hazard ratio 1.71, 95% confidence interval 1.02-2.86) and 6 months (adjusted hazard ratio 1.96, 95% confidence interval 1.21-3.16), but lidocaine was not at 30 days (adjusted hazard ratio 1.19, 95% confidence interval 0.77-1.82) or 6 months (adjusted hazard ratio 1.10, 95% confidence interval 0.73-1.66).

Conclusion: Among patients with acute myocardial infarction complicated by sustained ventricular tachycardia/ventricular fibrillation who survive 3 hrs, amiodarone, but not lidocaine, is associated with an increased risk of death, reinforcing the need for randomized trials in this population.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Survival at 3 hours (inset) and 30 days. A. Survival at 3 hours (inset) and 30 days according to amiodarone pharmacotherapy. B. Survival at 3 hours (inset) and 30 days according to lidocaine pharmacotherapy.
Figure 2
Figure 2
Survival at 3 hours (inset) and 30 days. A. Survival at 3 hours (inset) and 30 days according to amiodarone pharmacotherapy. B. Survival at 3 hours (inset) and 30 days according to lidocaine pharmacotherapy.
Figure 3
Figure 3
Risk of all-cause death at 30 days in patients with sustained VT/VF according to treatment with amiodarone or lidocaine. Shown are hazard ratios with 95% confidence intervals for all-cause death at 30 days according to treatment with amiodarone or lidocaine. Due to asymmetric hazards, these ratios are shown for early (0–3 hours after sustained VT/VF) and late (>3 hours) antiarrhythmic drug therapy.
See this image and copyright information in PMC

Comment in

References

    1. Newby KH, Thompson T, Stebbins A, et al. Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: incidence and outcomes. The GUSTO Investigators. Circulation. 1998;98:2567–2573. - PubMed
    1. Piccini JP, Berger JS, Brown DL. Early sustained ventricular arrhythmias complicating acute myocardial infarction. Am J Med. 2008;121:797–804. - PubMed
    1. Sadowski ZP, Alexander JH, Skrabucha B, et al. Multicenter randomized trial and a systematic overview of lidocaine in acute myocardial infarction. Am Heart J. 1999;137:792–798. - PubMed
    1. Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346:884–890. - PubMed
    1. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J Am Coll Cardiol. 2006;48:e247–e346. - PubMed

Publication types

MeSH terms