Letter to the Editor
Suppression by propranolol and amiodarone of an electrical storm refractory to metoprolol and amiodarone

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Abstract

A 60-year-old male patient with ischemic cardiomyopathy experienced an electrical storm 1 month after implantation of an internal cardioverter-defibrillator. Recurrent life-threatening episodes of ventricular tachycardia persisted despite maximal antiarrhythmic theraphy with amiodarone, metoprolol and mexiletine. After a total of more than 500 cardioversions, all antiarrhythmic medications were withdrawn, and the nonselective beta-blocker propranolol was initiated. Electrical stability was achieved and the patient was discharged on propranolol 400 mg/day. Two months later, a second arrhythmia cluster occurred that was controlled by the addition of amiodarone. The patient remains free of arrhythmia 15 months after the event with the combination of propranolol and amiodarone.

Section snippets

Case report

A 60-year-old man suffering from CHF secondary to ischemic heart disease with a left ventricular ejection fraction of 18%, was admitted to the hospital for treatment of multiple episodes of ventricular tachyarrhythmias at rates between 160 and 200 bpm, 1 month after the implantation of a cardioverter–defibrillator, model Photon DR, V-230 HV (St. Jude Medical, Minneapolis, MN).

The intravenous administration of lidocaine (4 mg/min) and amiodarone (40 mg/h) for 4 days, suppressed the most rapid

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