Prognostic benefits of prior amiodarone or β-blocker use before the onset of ventricular arrhythmia with hemodynamic collapse

• Published in: Heart and vessels 2021-09, Vol.36 (9), p.1430-1437
• Main Authors: Yoshie, Koji, Yamasaki, Masao, Yokoyama, Masaaki, Ueki, Yasushi, Tachibana, Eizo, Yonemoto, Naohiro, Nagao, Ken
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Amiodarone; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - therapeutic use; Arrhythmia; Arrhythmias, Cardiac; Beta blockers; Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Confidence intervals; Hemodynamics; Humans; Medical prognosis; Medicine; Medicine & Public Health; Original Article; Prognosis; Regression analysis; Statistical analysis; Survival; Syncope; Vascular Surgery; Ventricle; Ventricular Fibrillation - drug therapy
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-021-01821-2

Although antiarrhythmic drugs have long been used for the suppression of various types of arrhythmias, their prior use before the onset of ventricular arrhythmia with hemodynamic collapse and the effect on prognosis is not well known. Data from 1004 consecutive patients with cardiovascular shock in the Japanese Circulation Society’s Shock Registry were analyzed. Eighty-four cases of ventricular arrhythmia-induced shock and ROSC (return of spontaneous circulation) were divided into the prior amiodarone or β-blockers use group (Aβ group, n  = 27) and the non-amiodarone and non-β-blockers use group (non-Aβ group; n  = 57) based on treatment before the onset of those arrhythmias. Clinical outcomes related to hemodynamic collapse such as OHCA (out-of-hospital cardiovascular arrest) was less in the Aβ group [Aβ group, 11/26 (42%) vs. non-Aβ group, 41/56 (73%); p  = 0.007]. Similarly, syncope was less common in the Aβ group than in the non-Aβ group [Aβ group 4/27 (15%) vs. non-Aβ group 27/57 (47%); p  = 0.004]. Furthermore, prior amiodarone or β-blockers use before the onset of ventricular arrhythmias was strongly associated with both survival at discharge (odds ratio 3.19; 95% confidence interval 1.06–9.67; p  = 0.040) and neurological outcomes at discharge (odds ratio 3.96; 95% confidence interval 1.32–11.85; p  = 0.014) based on multivariate logistic regression analysis. Prior amiodarone or β-blockers use before the onset of malignant ventricular arrhythmia and maintaining appropriate blood concentrations in advance is associated with a good survival rate and better neurological outcomes after recovery from ventricular arrhythmia with hemodynamic collapse.