Randomized, Double-Blind Comparison of Intravenous Amiodarone and Bretylium in the Treatment of Patients With Recurrent, Hemodynamically Destabilizing Ventricular Tachycardia or Fibrillation

Kowey, Peter R.; Levine, Joseph; Herre, John M.; Pacifico, Antonio; Lindsay, Bruce D.; Plumb, Vance J.; Janosik, Denise L.; Kopelman, H.; Scheinman, Melvin M.

doi:10.1161/01.cir.92.11.3255

Cited by 271 publications

(132 citation statements)

References 28 publications

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“…But Gilmour's group (13) recently reported that the drugs verapamil (at high concentrations) and diacetyl monoxime, which flatten APD restitution by different mechanisms than does bretylium, also prevented VF in the normal canine left ventricle. And, as noted earlier, bretylium has been shown to abolish VF in both normal and diseased hearts (27)(28)(29)(30).…”

Section: Discussionsupporting

confidence: 53%

Preventing ventricular fibrillation by flattening cardiac restitution

Garfinkel

Kim

Voroshilovsky

et al. 2000

Proc. Natl. Acad. Sci. U.S.A.

492

418

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Ventricular fibrillation is the leading cause of sudden cardiac death. In fibrillation, fragmented electrical waves meander erratically through the heart muscle, creating disordered and ineffective contraction. Theoretical and computer studies, as well as recent experimental evidence, have suggested that fibrillation is created and sustained by the property of restitution of the cardiac action potential duration (that is, its dependence on the previous diastolic interval). The restitution hypothesis states that steeply sloped restitution curves create unstable wave propagation that results in wave break, the event that is necessary for fibrillation. Here we present experimental evidence supporting this idea. In particular, we identify the action of the drug bretylium as a prototype for the future development of effective restitution-based antifibrillatory agents. We show that bretylium acts in accord with the restitution hypothesis: by flattening restitution curves, it prevents wave break and thus prevents fibrillation. It even converts existing fibrillation, either to a periodic state (ventricular tachycardia, which is much more easily controlled) or to quiescent healthy tissue.

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Section: Discussionsupporting

confidence: 53%

Preventing ventricular fibrillation by flattening cardiac restitution

Garfinkel

Kim

Voroshilovsky

et al. 2000

Proc. Natl. Acad. Sci. U.S.A.

492

418

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“…One definition of electrical storm is recurrent ventricular tachycardia or fibrillation occurring two or more times in a 24-h period, usually requiring electrical cardioversion or defibrillation. 10,11 A broader use of the term ICD storm includes those patients who receive multiple shocks inappropriately for atrial fibrillation, lead fracture, electromagnetic noise, and so forth. The incidence of true ICD storm is estimated to occur in between 10 and 30% of all ICD recipients.…”

Section: Definition and Incidence Of Icd Stormmentioning

confidence: 99%

Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

Sears¹,

Conti²

2003

Clinical Cardiology

150

111

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Summary:The experience of shock is the distinguishing feature for patients with implantable cardioverter defibrillators (ICDs) and is associated with diminished psychological functioning and quality of life. Multiple shocks and ICD storm are a relatively common event among patients with ICDs (10-20%) and may present specific challenging medical and psychological management for the attending health care providers. This paper examines the medical and psychological aspects of ICD shocks and storms and describes a model of biopsychosocial management for patients following the experience of ICD storm. Successful management of patients post shock includes the use of antiarrhythmic medications and careful attention to the causality of the shocks via stored electrograms. The psychological management includes specific attention to debriefing post-shock feelings and attributions, preventing avoidance behavior, and facilitating positive "return to life" actions. Preliminary research examining formal psychosocial treatment supports a cognitive behavioral strategy to reduce psychological distress and facilitate quality of life. Collectively, these data suggest that interdisciplinary management of patients with multiple ICD shocks or the experience of ICD storm is advised, and routine psychological consultation may be indicated for the patient post ICD storm to reduce the possibility of symptoms of post-traumatic stress.

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“…60 Once again, the target amiodarone dose ratio of 8 to 1 was compressed to 1.8 to 1 as a result of open-label boluses. There was no significant difference in the primary outcome, which was median VT/VF recurrence rate over 24 hours.…”

Section: Short-term Control Of Vt/vfmentioning

confidence: 99%