Cardiac arrest and sudden death in patients treated with amiodarone for sustained ventricular tachycardia or ventricular fibrillation: risk stratification based on clinical variables |
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| Authors: | L A DiCarlo F Morady M J Sauve P Malone J C Davis T Evans-Bell S A Winston M M Scheinman |
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| Institution: | 1. Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Laboratory affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Corso della Repubblica 79, 04100 Latina, Italy;2. Department of Drug Chemistry and Technology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;3. Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 291, 00161 Rome, Italy;4. Department of Medical Biotechnologies and Translational Medicine, University of Milan, Via Fratelli Cervi 93, 20090, Segrate, Italy;5. National Center for Innovative Technologies in Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;1. Department of Emergency Medicine, University of California, Davis, Sacramento, California;2. Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania;3. Department of Emergency Medicine, University of Louisville, Louisville, Kentucky;4. Goldberg Kohn, Chicago, Illinois;1. Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, P.O. Box 2457, Saudi Arabia;2. Nanomedicine Unit (NMU-KSU), College of Pharmacy, King Saud University, Saudi Arabia;3. Department of Pharmaceutics, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt;4. Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt |
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| Abstract: | Multivariate analysis of 11 clinical variables was performed in 104 patients with sustained, symptomatic ventricular tachycardia (VT) or ventricular fibrillation treated with amiodarone to determine variables predictive of subsequent cardiac arrest or sudden death. Twenty-five patients (24%) had fatal or nonfatal cardiac arrest after 7.3 +/- 6.2 months (mean +/- standard deviation) of therapy. Multivariate analysis identified an ejection fraction of less than 0.40, syncope or cardiac arrest before amiodarone therapy, and VT (3 or more consecutive ventricular premature complexes) during predischarge ambulatory electrocardiographic monitoring as variables associated with a high risk of subsequent fatal or nonfatal cardiac arrest (p less than 0.03). Patients who had these 3 clinical variables had a much higher predicted incidence of cardiac arrest at 6 months (62%) and 12 months (76%) than did patients with an ejection fraction greater than 0.40, without syncope or cardiac arrest before amiodarone therapy, and without VT during predischarge ambulatory electrocardiographic monitoring (2% and 5%, respectively) (p less than 0.02). Risk stratification using clinical variables can predict which patients are at high risk of recurrent cardiac arrest or sudden death during amiodarone therapy. |
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