서론 대상환자 연구대상및방법 Table 1. Baseline clinical characteristics of the study patients Study patients 9 Age mean years 5818 Gender M/F 7/2 Risk factors smok

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1 Origlnal Articles Korean Circulation J 1998;288: 급성심근경색증환자에서발생한혈역동학적으로불안정한 심실부정맥에대한 Amiodarone 정주치료의임상적고찰 최유정 임상욱 박재완 황경화 안인섭 김준영오재인 박필원 김태용 조윤경 차동훈 Clinical Study of the Intravenous Amiodarone in Acute Myocardial Infarction with Life-Threatening Refractory Ventricular Tachyarrhythmias Yu-Jeong Choi, MD, Sang-Wook Lim, MD, Jae-Wan Park, MD, Kyung-Wha Whang, MD, In-Sup Ann, MD, Joon-Young Kim, MD, Jane C Oh, MD, Pil-Won Park, MD, Tae-Yong Kim, MD, Yoon-Kyung Cho, MD and Dong-Hoon Cha, MD. Cardiology Division, Department of Internal Medicine, Pundang Cha Hospital, Pocheon CHA University, Sungnam, Korea ABSTRACT BackgroundRecently, the amiodarone has emerged as a promising antiarrhythmic agent and its efficacy and safety has been widely accepted with many literatures. But there was no general agreement regarding the dosage and indication of intravenous IV amiodarone in acute myocardial infarction with life-threatening refractory ventricular tachyarrhythmias. MethodFrom October 1995 through October 1997, we recruited retrospectively 9 patients of acute myocardial infarction who had received IV amiodarone for life-threatening refractory ventricular tachyarrhythmias and analyzed the initial response, adverse effect, and loading dose. Results1 Acute efficacyeight of 9 patients promptly restored normal sinus rhythm immediately after intravenous amiodarone administration. 2 In-Hospital MortalityOne patients died due to ventricular tachyarrhythmias refractory to aggressive management and 5 in 8 patients who had responded promptly with IV amiodarone discharged alive and other 3 patients died due to cardiogenic shock with normal sinus rhythm. 3 Immediate adverse effectsfive patients experienced immediate adverse effects after IV amiodarone3 patients of hypotension, 1 patient of first degree AV block, and the other of Morbitz type 2 AV block. 4 Long term follow-upamong 5 patients discharged alive, one died as unexpected consequence. Other 4 patients have been still alive without maintenance medication. ConclusionThe IV amiodarone for suppression of life-threatening ventricular tachyarrhythmias in patients with acute myocardial infarction seemed to be an effective second-line therapeutic drug and have acceptable adverse effects. In the future, the large scale study regarding the dosage and indication might be warrented. Korean Circulation J 1998;288: KEY WORDSIntravenous amiodarone Acute myocardial infarction Ventricular tachyarrhythmias. 1314

2 서론 대상환자 연구대상및방법 Table 1. Baseline clinical characteristics of the study patients Study patients 9 Age mean years 5818 Gender M/F 7/2 Risk factors smoking 3 30% hypercholesterolemia 200 mg/dl 1 10% hypertension 4 40% diabetes 3 30% 1315

3 Amiodarone의정주방법과용량 Table 2. Description of 9 patients with myocardial infarction with life threatening ventricular tachyarrythmias Case Age / Sex Infarction Peak EF Ventricular arrythmia Onset* Morphology N Prior CardioversionN 1 45/M Inf hr VF 3 Lido /M Sep hr20min VT/VF 2 Lido /M In f hr40min VT/VF 9 Lido /M Ant-lat hr30min VT 10 Lido /M Ant-sep hr17min VF 6 Lido /M Ant-inf min VF 6 Lido /M Subendo 40 ` 3hr VT 6 Lido /F Inf hr VT 10 Lido /F Inf min VF 3 Lido 2 *denotes the onset time after initial symptom develops. InfInferior, Sepseptal, Ant-latanterolateral, Antsep anteroseptal, Ant-inf anteroinferior, Subendo subendocardial, CK creatinine kinase, EF ejection fraction, VFventricular fibrillation, VTventricular tachycardia, Lidolidocaine and Nnumber Table 3. Dose and response to treatment with intravenous amiodarone and long term outcome Case Initial bolus Repeat bolus Total bolus Maintenance dose Duration of maintenance Acute efficacy Outcome* Long-term outcome Side effect mg x2 600 mg 1200 mg 11/2 hr no F mg 150 mg 600 mg 3 days yes S F 1 AV block mg 150 mg 600 mg 5 days yes S S mg 300 mg 800 mg 3 days yes F hypotension mg x3 750 mg 600 mg 1 days yes S S mg x2 300 mg 600 mg 2 days yes S S mg 300 mg 600 mg yes F 2 AV block mg 300 mg 1000 mg 3 days yes F hypotension mg 150 mg 600 mg 3 days yes S S hypotension Hypotension was defined as reduction of systolic blood pressure more than 40 mmhg from baseline promptly after amiodarone administration *denotes in-hospital mortality. Fdie, Ssurvive and AVatrioventricular 1316 Korean Circulation J 1998;288:

4 추적관찰 결과 초기치료효과 생존환자수 심혈관부작용 추적조사 고안 1317

5 1318 Korean Circulation J 1998;288:

6 연구배경 : 요약 1319

7 방법 : 결과 : 결론 : 중심단어 1320 REFERENCES 1) Heger JJ, Prystowsky EN, Jackman WM, Naccarelli GV, Warfel KA, Rinkenberger RL, et al. Clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation. N Engl J Med ) Heger JJ, Prystowsky EN, Zipes DP. Clinical efficacy of amiodarone in treatment of recurrent ventricular tachycardia and ventricular fibrillation. Am Heart J ) Nademanee K, Singh BN, Hendrickson J, Intarachot V, Lopez B, Feld G, et al. Amiodarone in refractory lifethreatening ventricular arrhythmias. Ann Intern Med ) Morady F, Scheirman MM, Hess DS. Amiodarone in the management of patients with ventricular tachycardia and ventricular fibrillation. PACE ) Flaker GC, Alpert MA, Webel RR, Ruder MA, Sanfelippo JF, Tsutakawa RK. Amiodarone and sustained ventricular arrhythmias statistical evidence of drug effectiveness. Am Heart J ) Heger JJ, Prystowsky EN, Miles WAMA, Zipes DP. Clinical experience with amiodarone for treatemtn of recurrent ventricular tachycardia and ventricular fibrillation. Br J Clin Pract ) Aneeasen F, Agerbaek H, Bjerregaard P, Gotzsche H. Pharmacokinetics of amiodarone after intravenous and oral administration. Eur J Clin Pharmacol ) Watt AH, Hutchings A, Stephens MR, Routledge PA. Plasma amiodarone concentrations during intravenous infusion. Br J Clin Pharmacol ) Wellens HJ, Burgada P, Abdollah H, Dassen WR. A comparison of the electrophysiologic effects of intravenous and oral amiodarone in the same patient. Circulation ) Hariman RJ, Gomes JA, Kang PS, El-Sherif N. Effects of intravenous amiodarone in patients with inducible repetitive ventricular response and ventricular tachycardia. Am Heart J ) Saksena S, Rothbart ST, Shah Y, Capello G. Clinical efficacy and electropharmacology of continuous intravenous amiodarone infusion and chronic oral amiodarone in refractory ventricular tachycardia. Am J Cardiol : ) Morady F, Dicarlo LA Jr, Baerman JM, Krol RB. Ratedependent effects of intravenous lidocaine, procainamide, and amiodarone on intraventricular conduction. JACC ) Morady F, DiCarlo LA, Krol RB, Baerman JM, debuitleir M. Acute and chronic effects of amiodarone on ventricular refractoriness, intraventricular conduction and ventricular tachycardia induction. JACC ) Installe E, Schoevaerdts JC, Gadisseux P, Charles S, Tremouroux J. Intravenous amiodarone in the treatment of various arrhythmias following cardiac operations. J Thorac Cardiovasc Surg ) Chapman JR, Boyd MJ. Intravenous amiodarone in ventricular fibrillation. Br Med J , ) Morady F, Scheinman MM, Shen E, Shapiro W, Sung Korean Circulation J 1998;288:

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<B0E6C8F1B4EBB3BBB0FA20C0D3BBF3B0ADC1C E687770> 심전도연수강좌 : 처음시작하는사람들을위한심전도 연세대학교원주의과대학순환기내과학교실 안민수 Cardiac Electrophysiology I : Automaticity : 60-100 회 /min, His bundle : 40-60 회 /min Bundle branch : 20-40 회 /min Purkinje fiber : 20 회 /min Cardiac Electrophysiology