Abstract
Objective
To compare the efficacy and safety of intravenous (IV) amiodarone and procainamide for the treatment of atrial tachyarrhythmias (AT) in the critically ill.
Design
In this prospective study, patients were allocated to drug treatment on the basis of hospital identification number, even for procainamide and odd for amiodarone.
Setting
Patients were recruited from a teaching hospital ICU and did not include postoperative cardiac patients.
Patients and participants
26 patients with AT sustained for at least 1 h and failure to respond to correction of possible precipitating factors were entered in the study. Exclusion criteria were systolic blood pressure (SBP)<80 mmHg, and known hypersensitivity to either drug. Two patients with chronic atrial fibrillation (who received amiodarone) were later excluded from the analysis. In the final analysis, 14 patients received procainamide and 10 amiodarone.
Interventions
IV amiodarone (3 mg/kg followed by 10 mg/kg/24h, with repeat dose of 3 mg/kg at 1 h if no response) or IV procainamide (10 mg/kg at 1 mg/kg/min followed by infusion of 2–4 mg/min for 24 h, with repeat dose of 5 mg/kg at 1 h if no response).
Measurements and results
In the procainamide group 10/14 (71%) and in the amiodarone group 7/10 (70%) had converted to sinus rhythm by 12 h. There was no significant difference in response between the groups. SBP was not significantly different from baseline after administration of either drug.
Conclusions
Procainamide and amiodarone appear to be safe and equally effective in the treatment of AT in the critically ill.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arucio A, Pereira M (1990) Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med 18:1383–1388
Goldman S, Probst P, Selzer A, Cohn K (1975) Inefficacy of “therapeutic” serum levels of digoxin in controlling the ventricular rate in atrial fibrillation. Am J Cardiol 35:651–655
Falk RH, Knowlton AA, Bernard SA, Gotlieb NE, Battinelli (1987) Digoxin for converting recent-onset atrial fibrillation to sinus rhythm. Ann Intern Med 106:503–506
Edwards JD, Kishen R (1986) Significance and management of intractable supraventricular arrhythmias in critically ill patients. Crit Care Med 14:280–282
Holt (1989) Hemodynamic responses to amiodarone in the critically ill patient receiving catecholamine infusions. Crit Care Med 17:1270
Rotmensch HH, Belhassen B (1988) Amiodarone in the management of cardiac arrhythmias: current concepts. Med Clin North Am 72:321–359
Faniel R, Scoenfeld Ph (1983) Efficacy of IV amiodarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients. Eur Heart J 4:180–185
McAllister HF, Luke RA, Whitlock RM, Smith WM (1990) Intravenous amiodarone bolus versus oral quinidine for atrial flutter and fibrillation after cardiac operations. J Thorac Cardiovasc Surg 99:911–918
Installe E, Schoevaerdts JC, Gadisseux Ph, Charles S, Tremouroux J (1981) Intravenous amiodarone in the treatment of various arrhythmias following cardiac operations. J Thorac Cardiovasc Surg 81:302–308
Ledingham IMcA, Mcardle CS (1978) Prospective study of the treatment of septic shock. Lancet I:1194
Bittar G, Friedman HS, Nguyen T, Vorperian V, Dominquez A (1989) Cardiac electrophysiological effects of theophylline: influence of autonomic and calcium blockade. Clin Res 37:837 (abstract)
Kay GN (1990) Invited letter concerning: amiodarone and quinidine for postoperative atrial arrhythmias. J Thorac Cardiovasc Surg 99:991–998
Halpearn SW, Ellrodt G, Singh BH, Mandel WJ (1980) Efficacy of intravenous procainamide infusion in converting atrial fibrillation to sinus rhythm. Br Heart J 44:589–595
Fenster PE, Coomess KA, Marsh R, Katzenberg C, Hager D (1983) Conversion of atrial fibrillation to sinus rhythm by acute intravenous procainamide infusion. Am Heart J 106:501
Geninatti M (1990) Conversion of acute atrial fibrillation with procainamide. J Emerg Med 8:209–210
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Chapman, M.J., Moran, J.L., O'Fatharaigh, M.S. et al. Management of atrial tachyarrhythmias in the critically ill: A comparison of intravenous procainamide and amiodarone. Intensive Care Med 19, 48–52 (1993). https://doi.org/10.1007/BF01709278
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709278