Intravenous antiarrhythmic therapy in the acute control of in-hospital destabilizing ventricular tachycardia and fibrillation

Ventricular tachycardia, which causes hemodynamic instability, and ventricu lar fibrillation do not occur frequently in any hospital. However, they usu ally occur in patients who have severe underlying cardiovascular disease su ch as myocardial ischemia/infarction or congestive heart failure, and they are associated with high mortality. Most of those deaths are due to an intr actable arrhythmia, not suppressible with even the most potent antiarrhythm ic drugs. Fortunately, during the last few years, our ability to suppress h ighly lethal ventricular arrhythmia has been enhanced by the approval of in travenous amiodarone. When used in appropriate patient populations, intrave nous amiodarone has been successful in suppressing the most malignant arrhy thmia, thus permitting aggressive and successful treatment of severe underl ying cardiac conditions. This article reviews data on the use of parenteral antiarrhythmic drugs for the control of ventricular arrhythmia in patients in hospital, and will attempt to provide some guidance as to how these ant iarrhythmic drugs may be used in specific patient populations to maximize t heir efficacy and safety. We will also make recommendations on the sequence of therapy for specific arrhythmias to optimize the chances of patient sur vival. (C)1999 by Excerpta Medica, Inc.