Origlnal Articles Korean Circulation J 1998;288:1314-1321 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;288:1314-1321 KEY WORDSIntravenous amiodarone Acute myocardial infarction Ventricular tachyarrhythmias. 1314
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
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 648 0.62 9hr VF 3 Lido 3 2 77/M Sep 1889 0.60 2hr20min VT/VF 2 Lido 2 3 47/M In f 11605 0.48 1hr40min VT/VF 9 Lido 9 4 71/M Ant-lat 3711 0.20 1hr30min VT 10 Lido 2 5 36/M Ant-sep 23530 0.61 1hr17min VF 6 Lido 8 6 51/M Ant-inf 8273 0.65 45min VF 6 Lido 3 7 50/M Subendo 40 ` 3hr VT 6 Lido 4 8 62/F Inf 1183 0.44 6hr VT 10 Lido 2 9 79/F Inf 2142 0.30 40min 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 1 300 mg x2 600 mg 1200 mg 11/2 hr no F 2 150 mg 150 mg 600 mg 3 days yes S F 1 AV block 3 150 mg 150 mg 600 mg 5 days yes S S 4 300 mg 300 mg 800 mg 3 days yes F hypotension 5 150 mg x3 750 mg 600 mg 1 days yes S S 6 150 mg x2 300 mg 600 mg 2 days yes S S 7 300 mg 300 mg 600 mg yes F 2 AV block 8 300 mg 300 mg 1000 mg 3 days yes F hypotension 9 150 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;288:1314-1321
추적관찰 결과 초기치료효과 생존환자수 심혈관부작용 추적조사 고안 1317
1318 Korean Circulation J 1998;288:1314-1321
연구배경 : 요약 1319
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