Amiodarone-Induced Refractoriness to Cardioversion

Brief Reports1 May 1984Amiodarone-Induced Refractoriness to CardioversionRICHARD N. FOGOROS, M.D.RICHARD N. FOGOROS, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-100-5-699 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAmiodarone, an antiarrhythmic agent under investigation in the United States, is generally thought to be extremely effective and safe (1, 2). Recent reports, however, indicate a significant incidence of serious toxicity (3, 4). I report the case of a patient with a newly recognized toxicity, amiodarone-induced refractoriness to cardioversion.A 56-year-old man was referred for control of recurrent ventricular tachyarrhythmias. He had had two-vessel coronary artery bypass grafting 4 years earlier, and four previous myocardial infarctions, the most recent 6 weeks earlier. Recurrent ventricular tachycardia began 8 months previously, and the patient required emergent direct-current cardioversion twice.Electrophysiologic testing showed...References1. ROSENBAUMCHIALEHALPREN MPM. Clinical efficacy of amiodarone as an antiarrhythmic agent. Am J Cardiol. 1976;38:934-44. CrossrefMedlineGoogle Scholar2. NADEMANEEHENDRICKSONKANNANSINGH KJRB. Antiarrhythmic efficacy and electrophysiologic actions of amiodarone in patients with life-threatening ventricular arrhythmias: potent suppression of spontaneously occurring tachyarrhythmias versus inconsistent abolition of induced ventricular tachycardia. Am Heart J. 1982;103:950-9. MedlineGoogle Scholar3. WAXMANGROHMARCHLINSKI HWF. Amiodarone for control of sustained ventricular tachyarrhythmia: clinical and electrophysiologic effects in 51 patients. Am J Cardiol. 1982;50:1066-74. CrossrefMedlineGoogle Scholar4. FOGOROSANDERSONWINKLESWERDLOWMASON RKRCJ. Amiodarone: clinical efficacy and toxicity in 96 patients with recurrent, drug-refractory arrhythmias. Circulation. 1983;68:88-94. CrossrefMedlineGoogle Scholar5. MIROWSKIREIDMOWERWATKINSWEISFELDT MPMLM. The automatic implantable defibrillator. J Cardiovasc Med. 1982;7:498-510. Google Scholar6. WINKLEMASONGRIFFINRoss RJJD. Malignant ventricular tachyarrhythmias associated with the use of encainide. Am Heart J. 1981;102:857-64. CrossrefMedlineGoogle Scholar7. DESILVAGRAYBOYSPODRIDLOWN RTPB. Cardioversion and defibrillation. Am Heart J. 1980;100:881-95. CrossrefMedlineGoogle Scholar8. KERBERJENSONGASCHOGRAYZELHOYTKENNEDY RSJJRJ. Determinants of defibrillation: prospective analysis of 183 patients. Am J Cardiol. 1983;52:739-45. CrossrefMedlineGoogle Scholar9. BABBSYIMWHISTLERTACKERGEDDES CGSWL. Elevation of ventricular fibrillation threshold in dogs by antiarrhythmic drugs. Am Heart J. 1979;98:345-50. CrossrefMedlineGoogle Scholar This content is PDF only. 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