THE ROLE OF INTRAVENOUS AMIODARONE IN THE MANAGEMENT OF CARDIAC-ARRHYTHMIAS

Purpose: To review the electropharmacology, clinical applications, sid e effects, and hemodynamic profile of intravenous amiodarone. Data Sou rces: The MEDLINE database was searched for English-language material, including reports of clinical trials and in vivo studies, review arti cles, and abstracts presented al national symposia, that was published between 1985 and 1996. Bibliographies of textbooks and articles were also examined. Study Selection: Studies that reported on the efficacy, toxicity, and hemodynamic profile of intravenous amiodarone and studi es that examined the pharmacologic behavior of intravenous amiodarone in laboratory models were reviewed. Data Extraction: Study design and quality and relevant data on efficacy of suppression and treatment of arrhythmias with oral and intravenous amiodarone therapy, the reported mechanisms of antiarrhythmic effect, and hemodynamic changes seen wit h therapy were analyzed. Data Synthesis: Amiodarone is a unique antiar rhythmic agent that is now available in oral and intravenous forms in the United States. The use of intravenous amiodarone in the short-term treatment of life-threatening or hemodynamically unstable rhythm dist urbances has generated much interest. Amiodarone has many electropharm acologic actions, some of which differ between the oral and intravenou s forms. The wide clinical application of amiodarone includes treatmen t and prevention of supraventricular and ventricular arrhythmias and a rrhythmias related to myocardial infarction. Intravenous amiodarone is effective for supraventricular and ventricular arrhythmias that are r esistant to other antiarrhythmic agents. The effectiveness of intraven ous amiodarone as short-term treatment also suggests that the drug has an important role in protocols of advanced cardiac life support. Intr avenous amiodarone seems to have an overall favorable hemodynamic prof ile and does not produce many of the unwanted long-term side effects a ssociated with oral therapy. Conclusion: Intravenous amiodarone shows much promise for the short-term treatment of unstable arrhythmias. Its favorable hemodynamic effects and minimal short-term side effects mak e it an attractive option in the management of cardiac arrhythmias.