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DEAR DR. ROACH: I’m an 84-year-old male who recently experienced severe dizziness and was driven to the emergency room by my wife. They did a CT scan and several other tests, including an electrocardiogram (EKG). After the doctor looked at the EKG, he immediately ordered a second one. After reviewing the second one, he said that they had to get me on a heart monitor, so I was put on a bed and wheeled into a room where I was put on a monitor.
The monitor showed me to be in ventricular tachycardia with a sustained heart rate of about 140 bpm. They immediately administered amiodarone and finally reduced my heart rate to a safe range by the afternoon. They then performed an MRI on my heart and a coronary angiogram the next day. The tests showed that I had no further blockages in my heart or veins.
They then operated and placed an implantable cardioverter-defibrillator (ICD). I was discharged and placed on the pill form of amiodarone. My doctor tells me that I may have to be on this drug for the rest of my life. Because of the serious side effects that this drug can have on my lungs, liver, thyroid and vision, I’m very concerned. Can you tell me how often these side effects are experienced by patients and whether I have options in my situation? -- D.K.
ANSWER: Ventricular tachycardia is a life-threatening rhythm disturbance that requires immediate treatment, sometimes with medication or electric shocks. Because this condition can recur, treatment to reduce this risk is recommended. You’ve already received one important part of treatment; ICDs sense ventricular tachycardia (and its even more dangerous counterpart, ventricular fibrillation) quickly and deliver an electric shock automatically. They’ve been proven to save lives.
Medications like amiodarone have been used for many years, but one newer treatment is catheter ablation, where the part of the heart that’s responsible for the abnormal beats is carefully mapped. Then radiofrequency energy is used to destroy the area in which the ventricular tachycardia starts from. This procedure, however, carries risks, and being 84 puts you at a higher risk for complications.
The precise results of your angiogram and cardiac MRI are important. People with structural heart disease have a greater-than-40% risk of recurrence, which can cause sudden death. I’m guessing that you may have structural heart disease because if you had lower-risk VT, amiodarone wouldn’t typically be given, unless safer drugs and cardioversion weren’t options.
Amiodarone can be dangerous to the lungs. As many as 17% of people will develop lung toxicity during long-term use, and of those cases, it’s fatal about 10% of the time. Liver toxicity isn’t as common but can also cause severe damage and even death. The best estimate is that serious liver disease happens in 1% to 3% of people.
Thyroid disease can occur with amiodarone, both too much (2% of patients) and too little (10%). It’s treated like any other thyroid condition. Finally, amiodarone deposits can occur in the cornea, causing visual symptoms in about 10% of patients. Overall, about 20% of patients had to stop taking amiodarone.
Reading the list, it’s reasonable for a reader to wonder why anyone would take this drug with its list of side effects, which aren’t rare. The answer is that amiodarone probably remains the most-effective treatment we have. Other agents, especially sotalol, can be used and have fewer toxicities but aren’t as effective. Toxicities cause 17% of patients on sotalol to discontinue treatment.
There’s no ideal option that’s completely effective and free of side effects. Asking your doctor for alternatives is reasonable, as I don’t have enough information to be sure that amiodarone is necessary for you.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved