Ventricular Fibrillation Medication

Updated: Jun 06, 2018
  • Author: Sandeep K Goyal, MD, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Medication

Medication Summary

In acute ventricular fibrillation (VF), drugs (eg, vasopressin, epinephrine, amiodarone) are used after three defibrillation attempts are performed to restore normal rhythm. Amiodarone can also be used on a long-term basis in patients who refuse placement of an implantable cardioverter-defibrillator (ICD) or who are not candidates for an ICD. However, amiodarone has not been shown to be of value for primary prevention of VF in patients with a depressed left ventricular (LV) ejection fraction (LVEF).

In an analysis of the association between rearrest and intraresuscitation antiarrhythmic drugs in relation to the Resuscitation Outcomes Consortium (ROC) amiodarone, lidocaine, and placebo (ALPS) trial, investigators did not find a difference in rearrest rates between those who received amiodarone or lidocaine and those who received placebo. [117]  However, the electrocardiographic waveform characteristics were associated with the treatment group and rearrest, and rearrest was associated with poor survival and neurologic outcomes.

A retrospective study (2007-2013), using the nationwide Japanese Diagnosis Procedure Combination inpatient database comprising 2961 patients who had cardiogenic out-of-hospital cardiac arrest and who had VF on hospital arrival to assess the association between nifekalant or amiodarone on hospital admission and in-hospital mortality in these patients, found no significant in-hospital mortality association in the two groups but did reveal improved admission rates with nifekalant. [118]  These findings require additional investigation to confirm and validate the results.

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Antidysrhythmics, Ia

Class Summary

Class Ia antiarrhythmics increase the refractory periods of the atria and ventricles. Myocardial excitability is reduced by an increase in the threshold for excitation and inhibition of ectopic pacemaker activity.

Procainamide (Procanbid, Pronestyl, Pronestyl [SR])

Procainamide is a third-line drug of choice for VF. This drug is generally not recommended for VF patients, but because of its long loading time, it can be used to prevent recurrences of VF or for treatment of sustained ventricular tachycardia (VT).

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Antidysrhythmics, Ib

Class Summary

Class Ib antidysrhythmics suppress automaticity of conduction tissue by increasing the electrical stimulation threshold of the ventricle and His-Purkinje system and by inhibiting spontaneous depolarization of the ventricles during diastole by a direct action on the tissues. Class Ib antidysrhythmics block the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, resulting in inhibition of depolarization, with resultant blockade of conduction.

Lidocaine (Xylocaine, Nervocaine, LidoPen, Duo-Trach)

Lidocaine is a local anesthetic and a class Ib antiarrhythmic agent that increases the electrical stimulation threshold of the ventricle, suppressing the automaticity of conduction through the tissue. Class Ib agents particularly shorten the action potential. Lidocaine may be tried in patients with VT due to ischemia.

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Antidysrhythmics, III

Class Summary

Class III antidysrhythmics prolong the action potential duration. Some agents in this class inhibit adrenergic stimulation (alpha- and beta-blocking properties); affect sodium, potassium, and calcium channels; and prolong the action potential and refractory period in myocardial tissue. These effects result in decreased atrioventricular (AV) conduction and sinus node function.

Amiodarone (Pacerone, Cordarone, Nexterone)

Amiodarone is a class III antiarrhythmic agent indicated for the management of life-threatening recurrent VF.

Amiodarone may be administered intravenously or orally.

Recurrent VF that is not due to a reversible cause can be treated with intravenous (IV) amiodarone. It decreases AV conduction and sinus node function. It also prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation. Amiodarone can also be used orally on a long-term basis in patients who refuse ICDs, are not candidates for ICDs, or have frequent ventricular arrhythmias.

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Antidysrhythmics, V

Class Summary

Class V antidysrhythmics have a mechanism of action different from those of agents in classes I-IV; in many cases their mechanism of action is unknown.

Magnesium sulfate

Magnesium acts as an anti-arrhythmic agent and diminishes the frequency of premature ventricular contractions, particularly when secondary to acute ischemia. Clinical trials have been inconclusive in demonstrating its ability to improve mortality rates in the setting of refractory VF.

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Vasopressors

Class Summary

These agents augment the coronary and cerebral blood flow that is present during the low-flow state associated with hemodynamic compromise from VF.

Epinephrine (Adrenalin)

Epinephrine is considered to be the single most useful drug in cardiac arrest, although it has never been shown to benefit long-term survival or functional recovery. Epinephrine stimulates alpha, beta1, and beta2 receptors, resulting in relaxation of smooth muscle, cardiac stimulation, and dilation of muscle vasculature.

Vasopressin (ADH, Pitressin)

Vasopressin is a peptide hormone that regulates the body's retention of water by increasing water absorption in the collecting duct of the kidney nephron. It also increases arterial blood pressure by affecting peripheral vascular resistance.

Vasopressin has an off-label indication for VF that is causing pulseless arrest. This agent may improve vital organ blood flow, cerebral oxygen delivery, the patient's ability to be resuscitated, and the patient's neurologic recovery.

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