emDocs - August 11, 2014 - By Ben Cooper
..."The main focus of this post is to malign the myth that amiodarone is superior to procainamide for stable ventricular tachycardia. So, let’s get to it.
Unfortunately, there are no prospective, randomized, head-to-head trials comparing amiodarone to procainamide. There are, however, two retrospective case series’ suggesting that the success rate of amiodarone for conversion within 20 minutes is 29% (5,7). There is one retrospective cohort comparing amiodarone to procainamide that found success rates for conversion within 20 minutes to be 25% and 30%, respectively (not statistically significant) (8). However, when looking at only those that were given amiodarone or procainamide as the initial antidysrhythmic treatment, the success rates were 25%, and 57%, respectively (again, not statistically significant). Prior studies comparing the efficacy of procainamide to lidocaine suggest that the success rate of procainamide is closer to 80% (3, 4). What I conclude from the evidence is that successful conversion when administering amiodarone is around 30%, and when administering procainamide, 50% to 80%. This is all summarized in a nice systematic review by de Souza, et al (9)..."
http://www.emdocs.net/amiodarone-vs-procainamide-stable-vt/
