Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: a systematic review
Ian S deSouza1, Jennifer L Martindale1, Richard Sinert1
1SUNY Downstate/Kings County Hospital, New York, USA.
Objective:
We performed a systematic review of the literature to compare the efficacy of different drug therapies for the termination of stable, monomorphic ventricular tachycardia (VT).
Methods:
We searched EMBASE, MEDLINE and Cochrane for trials from 1965 through July 2013 using a search strategy derived from the following clinical question in PICO format:
Patients:
Adults (≥18 years) with stable monomorphic VT;
Intervention:
Intravenous antidysrhythmic drug; Comparator: Intravenous lidocaine or amiodarone;
Outcome:
Termination of VT. For all drug comparisons, we calculated relative risks (RR; 95% CI) and number needed to treat (NNT, 95% CI) between drugs. We also evaluated the methodological quality of the studies.
Results:
Our search yielded 219 articles by PubMed and 390 articles by EMBASE. 3 prospective studies (n=93 patients) and 2 retrospective studies (n=173 patients) met our inclusion and exclusion criteria. From the prospective studies, RR of VT termination of procainamide versus lidocaine was 3.7 (1.3-10.5); ajmaline versus lidocaine, RR=5.3 (1.4-20.5); and sotalol versus lidocaine, RR=3.9 (1.3-11.5). From the retrospective studies: procainamide versus lidocaine, RR=2.2 (1.2-4.0); and procainamide versus amiodarone RR=4.3 (0.8-23.6). All 5 reviewed studies had quality issues, including potential bias for randomisation and concealment.
Conclusions:
Based on limited available evidence from small heterogeneous human studies, for the treatment of stable, monomorphic VT, procainamide, ajmaline and sotalol were all superior to lidocaine; amiodarone was not more effective than procainamide.
Insights
Procainamide, ajmaline, and sotalol effectively terminate stable ventricular tachycardia (VT), outperforming lidocaine. Amiodarone showed no superior efficacy compared to procainamide in VT treatment.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Monomorphic ventricular tachycardia (VT) is a significant arrhythmia requiring effective drug therapy.
- Current treatment guidelines often recommend lidocaine as a first-line agent for stable VT.
Purpose of the Study:
- To systematically review and compare the efficacy of various intravenous antidysrhythmic drugs for terminating stable, monomorphic VT.
- To evaluate the relative effectiveness of procainamide, ajmaline, sotalol, and amiodarone against lidocaine and each other.
Main Methods:
- Systematic literature review of EMBASE, MEDLINE, and Cochrane databases (1965-July 2013).
- Inclusion of 3 prospective and 2 retrospective studies involving adult patients with stable monomorphic VT.
- Calculation of relative risks (RR) and number needed to treat (NNT) for VT termination, alongside methodological quality assessment.
Main Results:
- Procainamide demonstrated superior VT termination rates compared to lidocaine (RR 3.7 prospective, 2.2 retrospective).
- Ajmaline (RR 5.3) and sotalol (RR 3.9) also showed significantly higher efficacy than lidocaine in prospective studies.
- Procainamide was more effective than amiodarone (RR 4.3) in retrospective analysis; however, all included studies had quality limitations.
Conclusions:
- Procainamide, ajmaline, and sotalol are more effective than lidocaine for stable monomorphic VT termination.
- Amiodarone's efficacy is comparable to procainamide, but evidence is limited.
- Further high-quality research is needed to definitively establish optimal drug therapy for stable monomorphic VT.
Related Concept Videos
01:25Dysrhythmias VI: Management of Dysrhythmias
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers