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.1, 2, 3 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.4 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.
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