Objective  To explore the effect of aortic root perfusion of amiodarone when intractable ventricular fibrillation occurs during valve replacement. Methods  Totally 42 patients were selected as a drug group, who underwent intractable ventricular fibrillation following ascending aortic opening in valve replacement in Beijing Anzhen Hospital from October 2006 to October 2016. There were 26 males and 16 females with an average age of 56.31±12.56 years. The aorta was re-blocked when intractable ventricular fibrillation occured, amiodarone (150 mg diluted to 20 ml) through the aortic root perfusion tube was applicated, and suction was repeated 8-10 times with the cumulative amount of 150-200 ml, and then the ascending aorta was opened and fast compressed with a frequency of 200 times/min. While 53 patients with the same condition during the same period were selected as a control group. There were 35 males and 18 females with an average age of 58.79±19.81 years. The commonly used clinical treatment method of intractable ventricular fibrillation was adopted, such as continuous intravenous injection of 1 mg/kg lidocaine, while ascending aortic was re-blocked. The warm blood perfusion was given until the heart re-beated. The clinical outcomes were compared between the two groups. Results  There was one perioperative death in the drug group and two deaths in the control group during perioperative period. Defibrillation frequency (3.11±0.59 times vs. 4.91±1.34 times, t=–2.917, P=0.000), heart rate 5 min after re-beating (91.65±9.81 beats/min vs. 98.32±10.21 beats/min, t=–2.019, P=0.032), cardiopulmonary bypass time (71.68±10.21 min vs. 81.59±12.93 min, t=–2.512, P=0.032), dopamine dosage (4.32±1.28 μg·kg^–1·min^–1 vs. 5.79±1.98 μg·kg^–1·min^–1, t=–2.781, P=0.015), epinephrine dosage (0.03±0.01 μg·kg^–1·min^–1 vs. 0.06±0.02 μg·kg^–1·min^–1, t=–3.996, P=0.000) and norepinephrine dosage (0.01±0.01 μg·kg^–1·min^–1 vs. 0.03±0.01 μg·kg^–1·min^–1, t=–4.163, P=0.000) of the drug group were significantly shorter or lower than those of the control group. The rate of cardiac rhythm 5 min after re-beating (42.8% vs. 9.4%, χ²=11.211, P=0.000) of the drug group was higher than that of the control group. Conclusion  During intractable ventricular fibrillation following ascending aortic opening in valve replacemen, re-blocking the aorta and amiodarone reperfusion of the aortic root can significantly improve the heart re-beating rate and avoid ventricular re-fibrillation, shorten the cardiopulmonary bypass time and reduce the dosage of inotropic drugs.

Citation： ZHAO Tiefu, WANG Shengyu, CHEN Hong, ZHANG Chunxiao, Zhang Ming. Application of amiodarone in the treatment of intractable ventricular fibrillation following ascending aortic opening in valve replacement: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(7): 583-586. doi: 10.7507/1007-4848.201706001 Copy

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