Intravenous amiodarone homogeneously prolongs ventricular repolarization in patients with life-threatening ventricular tachyarrhythmia

Background: The most critical adverse effects of class Ill drugs are marked QT prolongation and torsade de pointes. Even though intravenous amiodarone (iv-Amio) is a representative class Ill drug, it peculiarly inhibits both clinical ventricular tachycardia/fibrillation (VT/VF) and proarrhythmic effects. To test the hypothesis that iv-Amio homogeneously prolongs repolarization, we evaluated electrocardiographic changes before and during short-term amiodarone therapy, focusing closely on the ventricular dispersion of repolarization. Methods: Twenty-seven consecutive patients treated with iv-Amio for VT/VF as a first-line antiarrhythmic therapy were enrolled in this study. Twelve-lead electrocardiography was recorded before and during amiodarone therapy to evaluate the following electrocardiographic intervals: R-R, QRS, QT, QRS to T-peak (QTp), and T-peak to T-end (Tp-e; as an index of dispersion of repolarization). Repolarization indices were corrected to the heart rate by Bazett's method (QTc, c-QTp, c-Tp-e). Results: Amiodarone suppressed VT/VF in 19/27 (70%) patients without conferring any proarrhythmic effect. The QTc, c-QTp, and R-R interval were significantly prolonged during amiodarone (476 +/- 45 ms vs 511 +/- 45 ms, p < 0.05; 338 +/- 40 ms vs 364 35 ms, p < 0.05; 762 +/- 272 ms vs 870 189 ms, p < 0.05; respectively), whereas the c-Tp-e and QRS durations did not change significantly (139 33 ms vs 145 +/- 41 ms, p = 0.25; 96 +/- 20 ms vs 97 +/- 21 ms, p = 0.33; respectively). Conclusions: Iv-Amio homogeneously prolongs repolarization and properly inhibits original VT/VF recurrence without inducing torsade de pointes. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.