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Previous Chapter. Next Chapter. Suyderhoud J. In the catheterization laboratory, amiodarone is contraindicated in patients with cardiogenic shock, severe bradycardia, and high degree AV block. Amiodarone is generally preferred over lidocaine for recurrent ventricular arrhythmias in other settings. Although routine prophylactic lidocaine reduces the incidence of ventricular fibrillation in acute MI, it is no longer recommended because it increases overall mortality.
Lidocaine is contraindicated in patients with severe sinus node dysfunction or advanced AV block. Chronic amiodarone has several adverse effects, but acutely IV amiodarone may cause bradycardia, heart block, hypotension due to systemic vasodilation, heart failure, or arrhythmias.
The predominant side effects of lidocaine are related to the central nervous system. Slurred speech, paresthesia, tremors, ataxia, drowsiness, delirium, seizures, and respiratory arrest can occur and are generally associated with toxic plasma levels. Symptoms resolve with a decrease in dose or discontinuation of the drug. Cardiovascular side effects are infrequent but may include bradycardia, asystole, and hypotension. Excessive doses can produce anticholinergic symptoms, such as flushing, delirium, blurry vision, and ataxia.
Vassallo, P, Trohman, RG. Excellent systematic review from the literature inclusive of 92 studies examining the efficacy of amiodarone for different arrhythmias and in various clinical conditions as well as its safety profile.
Authoritative and updated guideline from the ACCF, AHA, and HRS on the management of atrial fibrillation, inclusive of detailed sections on amiodarone and other antiarrhythmic medications. J Am Coll Cardiol. Authoritative guideline from the ACCF, AHA, and ESC and other societies on the management of ventricular arrhythmias and prevention of sudden cardiac death, inclusive of detailed sections on amiodarone, lidocaine, and other antiarrhythmic medications.
Authoritative guideline describing the clinical use of amiodarone, lidocaine, atropine and other drugs for the treatment of hemodynamically unstable and symptomatic bradyarrhythmias and tachyarrhythmias. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Show More. Login Register. Read an unlimited amount by logging in or registering at no cost.
General including evidence of efficacy A variety of arrhythmias may be encountered during coronary angiography and intervention. Antidysrhythmics include all medications that are used to treat any of these various dysrhythmias. The importance of dysrhythmia management in the modern practice of medicine cannot be overstated, as dysrhythmias are among the most common causes of preventable sudden cardiac death.
For a long time antidysrhythmics were considered among the most rational of the available cardiac medications. This well-earned reputation related to their high efficacy at reducing the incidence of malignant dysrhythmias. Similarly, they are effective at controlling discomforting rhythm disorders.
However, this approach changed dramatically following publication of the Cardiac Arrhythmia Suppression Trials CAST and CAST II , 23 and, more recently, with the rise of mechanical interventions, such as ablation therapy and implantable defibrillators. CAST assessed the ability of three antidysrhythmics to suppress asymptomatic ventricular dysrhythmias known to be harbingers of sudden death. The original CAST was discontinued in before completion, when encainide and flecainide, two of the study medications, not only failed to prevent sudden death but actually increased overall mortality.
Since patients with atrial fibrillation do not benefit from rhythm conversion compared to control of the ventricular response rate, the use of antidysrhythmics for this indication is now uncommon. In addition to the predictable, mechanism-based adverse effect of each medication, unique and often unanticipated effects also occur.
This chapter focuses on the medications that serve primarily as antidysrhythmics and, with the exception of lidocaine Chap. Chapter 16 provides a more detailed description of the electrophysiology of dysrhythmias and a discussion of their genesis. Despite an incomplete understanding of the underlying mechanisms of dysrhythmia formation, an abundance of antidysrhythmics have been developed, each attempting to alter specific electrophysiologic components of the cardiac impulse generating or conducting system.
Generally, antidysrhythmics manifest electrophysiologic effects either through alteration of the channel pore or, more commonly, by modification of its gating mechanism Fig. Unfortunately, given their exceedingly complex mechanisms of action, the descriptive terms used to explain their Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. This div only appears when the trigger link is hovered over.
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