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Canadian Journal of Cardiology

Inotropes and Arrhythmias: Are We Doing Harm or Guilt by Association?

  • Simon Christie
    Affiliations
    Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Marc W. Deyell
    Correspondence
    Corresponding author: Dr Marc Deyell, Heart Rhythm Services, St. Paul’s Hospital, #200, 1033 Davie Street, Vancouver, British Columbia V6N 2N1, Canada. Tel.: +1-604-806-8256; fax: +1-604-806-8723.
    Affiliations
    Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    Search for articles by this author
Published:October 10, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.004
      Inotropic agents are ubiquitous in the pharmacologic management of cardiogenic shock. The 2 most commonly used agents in North America are milrinone, a phosphodiesterase-3 inhibitor, and dobutamine, a predominately β-1 receptor agonist with mild β-2 and α-1 agonism.
      • Leier C.V.
      • Unverferth D.V.
      Drugs five years later: dobutamine.
      • Francis G.S.
      • Bartos J.A.
      • Adatya S.
      • Jentzer J.C.
      • Coons J.C.
      • Link C.B.
      • Schmidhofer M.
      Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit.
      The use of these agents has been associated with increased incidence of arrhythmias, some of which may be caused by proarrhythmic effects of the agents themselves, but—equally—the arrhythmias may be a consequence of the underlying cardiac condition. There are few studies comparing outcomes, especially arrhythmia outcomes, between these agents in the setting of cardiogenic shock.
      • Uhlig K.
      • Efremov L.
      • Tongers J.
      • et al.
      Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome.
      In this issue of the Canadian Journal of Cardiology, Jung and colleagues provide an important contribution through their report on arrhythmia outcomes in the Dobutamine Compared to Milrinone (DOREMI) randomized trial.
      • Jung R.G.
      • Di Santo P.
      • Mathew R.
      • et al.
      Arrhythmic events and mortality in patients with cardiogenic shock on inotropic support: results of the DOREMI randomized trial.
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