Amiodarone is regarded as one of the most efficacious antiarrhythmic agents because of its usefulness in the management of a variety of cardiac rhythm disorders with minimal tendency for induction of torsades de pointes tachyarrhythmia. Its use, however, is limited by the multiple and severe noncardiac side effects that it produces.
Amiodarone is available as an IV formulation as well as an oral preparation. IV amiodarone is indicated for initiating treatment and for prophylaxis of frequently recurring ventricular fibrillation and hemody-
namically unstable ventricular tachycardia in patients refractory to other therapy. IV administration also can be used to treat patients with ventricular tachycardia or ventricular fibrillation for whom oral amiodarone is indicated, but who are unable to take oral medication.
Amiodarone may elicit life-threatening side effects in addition to presenting substantial management difficulties associated with its use. The oral formulation of amiodarone is indicated only for the treatment of life-threatening recurrent ventricular arrhythmias (e.g., recurrent ventricular fibrillation and/or recurrent hemo-dynamically unstable ventricular tachycardia) that have not responded to other potentially effective antiar-rhythmic drugs or when alternative interventions could not be tolerated. Despite its efficacy as an antiarrhyth-mic agent, there is no evidence from clinical trials that the use of amiodarone favorably affects survival.
Initiation of treatment with amiodarone should be done in the hospital setting and only by physicians familiar with the management of patients with life-threatening arrhythmias; this is because of the life-threatening nature of the arrhythmias and the possibility of interactions with previous therapy and of exacerbation of the arrhythmia.
Amiodarone is effective in maintaining sinus rhythm in most patients with paroxysmal atrial fibrillation and in many patients with persistent atrial fibrillation. It is also effective in preventing recurrences of A-V nodal reentry and atrial tachyarrhythmias and in the prevention of reentrant rhythms and atrial fibrillation in patients with Wolff-Parkinson-White syndrome. Also, it is the most efficacious therapy for postoperative junctional ectopic tachycardia.
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