Amiodarone-Induced Refractoriness to Cardioversion
Authors: RICHARD N. FOGOROS
Journal: Annals of Internal Medicine (1984)

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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Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByFirst Case of Acute Poisoning with Amiodarone and Flecainide in Attempted Suicide Successfully Managed with Lipid Emulsion Therapy in the Emergency Department: Case Report and Literature ReviewAmiodaroneDrug-implantable cardioverter–defibrillator interactionsElevated Impedance During Cardioversion in Neonates with Atrial FlutterClinical Study of the Acute Effects of Intravenous Nifekalant on the Defibrillation Threshold in Patients With Persistent and Paroxysmal Atrial FibrillationEffect of Drugs on Defibrillation CapacityTesting and Programming of Implantable Defibrillator Functions at ImplantationHypertrophic cardiomyopathy with massive hypertrophy, amiodarone treatment and high defibrillation threshold at cardioverter–defibrillator implantHigh defibrillation threshold at cardioverter defibrillator implantation under amiodarone treatment: Favorable effects of D,L -sotalolAmiodarone and Defibrillation Thresholds:.DRUG THERAPY OF SUSTAINED VENTRICULAR TACHYARRHYTHMIASIntravenous sotalol decreases transthoracic cardioversion energy requirement for chronic atrial fibrillation in humans: assessment of the electrophysiological effects by biatrial basket electrodesImplantable Cardioverter-Defibrillator TherapyEffect of electrode polarity on the energy required for transthoracic atrial defibrillationFacilitating Transthoracic Cardioversion of Atrial Fibrillation with Ibutilide PretreatmentEffect of amiodarone and sotalol on the defibrillation threshold in comparison to patients without antiarrhythmic drug treatmentInteractions between implantable cardioverter-defibrillators and class III agentsEffects of Amiodarone and Its Active Metabolite Desethylamiodarone on the Ventricular Defibrillation ThresholdEffects of Long-Term Amiodarone Treatment on Ventricular-Fibrillation Vulnerability and Defibrillation Efficacy in Response to Monophasic and Biphasic ShocksA Comparison of Transvenous Atrial Defibrillation of Acute and Chronic Atrial Fibrillation and the Effect of Intravenous Sotalol on Human Atrial Defibrillation ThresholdICD-Antiarrhythmic Drug and ICD-Pacemaker InteractionsEffects of Lidocaine, Ajmaline, and Diltiazem on Ventricular Defibrillation Energy Requirements in Isolated Rabbit HeartRelation Between Amiodarone and Desethylamiodarone Plasma Concentrations and Ventricular Defibrillation Energy Requirementsd-Sotalol Decreases Defibrillation Energy Requirements in Humans:.Influence of Hypertonic Saline Solution Infusion on Defibrillation EfficacyEffects of oral propafenone on defibrillation and pacing thresholds in patients receiving implantable cardioverter-defibrillatorsMechanisms of antiarrhythmic drug-induced changes in defibrillation threshold: Role of potassium and sodium channel conductanceClass III Antiarrhythmic Effects of LY-190147 on Defibrillation ThresholdThe Defibrillation ThresholdDifferential Effects of Lidocaine on Defibrillation Threshold With Monophasic Versus Biphasic Shock WaveformsSafety of implantation of a cardioverter-defibrillator without general anesthesia in an electrophysiology laboratoryAntiarrhythmic Drugs in Patients with an Automatic Implantable DefibrillatorPredictors of Defibrillation Energy Requirements with Nonepicardial Lead SystemsLiteraturThe Pacer-Cardioverter-Defibrillator:.Why Do Some Patients Have High Defibrillation Thresholds at Defibrillator Implantation?.Effect of sotalol on ventricular fibrillation and defibrillation in humansConcomitant Amiodarone and the Implantable Cardioverter-Defibrillator: Is There a Place?Effects of Antiarrhythmic Drugs on Epicardial Defibrillation Energy Requirements and the Rate of Defibrillator DischargesEffects of chronic amiodarone therapy on defibrillation thresholdDefibrillation and CardioversionClinical characteristics and outcome of patients with high defibrillation thresholds. 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