Effect of milrinone on ventricular arrhythmias in congestive heart failure

Abstract

M ilrinone is a nonglycoside, noncatecholamine inotropic agent that has been shown to exhibit inotropic and vasodilatory effects in patients with severe congestive heart failure (CHF).’ 4 It is a bipyridine analog of amrinone that has been shown in experimental studies to be significantly more potent than the parent compound on a per weight basis. Although its mechanism of action has not been fully delined, it has been suggested that enhancement of calcium ion fluxes in the myocardial cell is contributory.5 Heart failure secondary to verapamil or propanolol can be improved with milrinone and its inotropic effect can be detected despite concomitant therapy with either catecholamine or glycoside agents. The effect of milrinone on ventricular arrhythmias has not been completely delined. Several studies have suggested that ventricular arrhythmias can be exacerbated in some patients treated with either amrinone6 or milrinone.’ L, Ventricular arrhythmias, including complex features such as nonsustained ventricular tachycardia (VT), are common in patients with CHF and have been implicated in the high mortality of the disease. lo We attempted to determine if chronic treatment with milrinone affects the prevalence and complexity of ventricular arrhythmias in patients with CHF.