Corrections to a Meta-Analysis of Oseltamivir Use in Preventing Hospitalization for Influenza

Abstract

In Reply I thank Lin and He for their interest in my case report. 1 Most of their points were already addressed in detail, however. Determining the cause of bidirectional ventricular tachycardia (BVT) was clearly addressed when I stated that "treatment of BVT should consider the cause of the arrhythmia." 1 Gastric lavage for treatment of aconitine ingestion was also mentioned.Administering oral sodium channel-blockers, such as mexiletine, flecainide, and amiodarone, as suggested by Lin and He, is inappropriate for the treatment of ventricular tachycardia in the acute setting. Intravenous lidocaine and amiodarone may be ineffective. 2,3 Intravenous phenytoin, a potent class 1B (sodium channel-blocker) antiarrhythmic agent was used successfully to treat BVT, as referenced in my report. 3,4 There is no question that immediate electrical cardioversion is indicated in cases of tachyarrhythmias associated with hemodynamic instability, ongoing ischemia, or acute heart failure. This was also spelled out in the main body of my report: "Cardioversion is used if the patient is unstable, or if other treatments fail," and in the take-home points, "Traditional antiarrhythmic agents may fail in terminating BVT. Cardioversion is the last resort." 1 Lin and He took that last sentence of the case report out of context. Electrical cardioversion is effective in terminating BVT. 2,5 Having said that, I agree that electrical cardioversion can precipitate severe rhythm disturbances in patients with severe digitalis toxicity and should be used with caution.