Amiodarone in Patients with Previous Drug-Mediated Torsade de Pointes

Mattioni, Thomas A.; Zheutlin, Terry; Sarmiento, Joseph J.; Parker, Michele; Lesch, Michael; Kehoe, Richard F.

doi:10.7326/0003-4819-111-7-574

Cited by 91 publications

(23 citation statements)

References 19 publications

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“…Amiodarone markedly prolongs the ventricular APD and increases the QT interval by 20%, yet the incidence of torsade de pointes with long-term use is estimated to be Ͻ1%. 15,16 The low incidence of torsade de pointes with long-term amiodarone therapy may be multifactorial. Recent evidence suggests that the dispersion of repolarization is a critical factor in the maintenance of torsade de pointes.…”

Section: Proarrhythmic Potentialmentioning

confidence: 99%

“…28 Finally, its ability to exert ␤-adrenergic receptor antagonism may also help suppress triggered activity. [13][14][15][16] …”

Section: Proarrhythmic Potentialmentioning

confidence: 99%

“…13,14 However, the incidence of torsade de pointes due to amiodarone is low. 15,16 Long-term amiodarone therapy is commonly used for the maintenance of sinus rhythm for patients with paroxysmal atrial fibrillation. With the recurrence of atrial fibrillation, the clinician is faced with a choice of electrical versus chemical cardioversion.…”

mentioning

confidence: 99%

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Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

et al. 2001

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Background-Ibutilide is a class III drug that is used for the cardioversion of atrial arrhythmias, but it can cause torsade de pointes. Amiodarone also prolongs the QT interval but rarely causes torsade de pointes. There are no studies in which the concomitant use of the 2 agents was examined. The purpose of the present study was to assess the efficacy and safety of cardioversion with combination therapy in patients with atrial fibrillation or flutter. Methods and Results-The study included 70 patients who were treated with long-term oral amiodarone and were referred for elective cardioversion of atrial fibrillation (57 of 70, 81%) or flutter (13 of 70, 19%). Patients were taking amiodarone (153Ϯ259 days, meanϮSD) and were administered 2 mg intravenous ibutilide. Left ventricular ejection fraction was measured with echocardiography. The QT intervals were measured on 12-lead ECG. Fifty-five patients (79%) had structural heart disease. Patients were in arrhythmia for 196Ϯ508 days before cardioversion, with a left ventricular ejection fraction of 50Ϯ11%. In patients with atrial fibrillation, 22 (39%) of 57 and 7 (54%) of 13 patients with flutter converted within 30 minutes of infusion. Thirty-nine patients who did not convert after ibutilide were treated with electrical cardioversion, and 35 (90%) of 39 patients were successfully converted. The QT intervals were further prolonged after ibutilide for the group from 371Ϯ61 to 479Ϯ92 ms (PϽ0.001). There was 1 episode of nonsustained torsade de pointes (1 of 70, 1.4%) after ibutilide. Conclusions-The use of ibutilide converted 54% of patients with atrial flutter and 39% of patients with atrial fibrillation who were treated with long-term amiodarone. Despite QT-interval prolongation after ibutilide, only 1 episode of torsade de pointes occurred. Our observations suggest that combination therapy may be a useful cardioversion method for chronic atrial fibrillation or flutter.

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Section: Proarrhythmic Potentialmentioning

confidence: 99%

“…28 Finally, its ability to exert ␤-adrenergic receptor antagonism may also help suppress triggered activity. [13][14][15][16] …”

Section: Proarrhythmic Potentialmentioning

confidence: 99%

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Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

et al. 2001

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“…5,8,22 The multiple ion channel interaction by amiodarone has been speculated to contribute to its minimal reverse use dependency and low incidence of clinical TdP arrhythmias, even in patients who develop TdP on other antiarrhythmics. 5,[22][23][24] Dronedarone, given either long-term or shortterm, has been suggested to possess a similar electrophysiological profile, but the effects of chronic dronedarone on specific cardiac ion channels are still unknown. [7][8][9] Arrhythmic Parameters: Dispersion…”

Section: Van Opstal Et Al Amiodarone In An Animal Model Of Acquired Lmentioning

confidence: 99%

Chronic Amiodarone Evokes No Torsade de Pointes Arrhythmias Despite QT Lengthening in an Animal Model of Acquired Long-QT Syndrome

et al. 2001

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Background-Amiodarone is an effective antiarrhythmic drug rarely associated with torsade de pointes arrhythmias (TdP).The noniodinated compound dronedarone could resemble amiodarone and be devoid of the adverse effects. In the dog with chronic complete atrioventricular (AV) block (CAVB) and acquired long-QT syndrome, the electrophysiological and proarrhythmic properties of the drugs were compared after 4 weeks of oral treatment. Methods and Results-Amiodarone (nϭ7, 40 mg · kg Ϫ1 · d

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“…İlaç-etkileşimli TdP olgularında her ne kadar amiodaron kullanımı güvenli olarak kabul edilse de nadiren de olsa amiodaronun kendi yan etkisi olarak TdP ortaya çıkabilmektedir (2,3) . Bizim hastamızda da amiodaronun kesilmesi sonrasında QTd'nin kendiliğinden gerilemesi amiodaronun miyokardiyal aktivasyon ve geri dönüşüm süresine olan etkisini göstermektedir.…”

Section: Discussionunclassified

Prolonged QT with Multiple-Causation and its Succesful Multistage Therapy

Keskin¹,

Alper²,

Türkkan³

et al. 2017

Kosuyolu Heart Journal

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GİRİŞUzun QT sendromu (UQTS); yüzey elektrokardiyografi (EKG)'sinde QT aralığının kazanılmış veya kalıtımsal sebeplerle uzamasıdır. Bu durum torsadesde pointes ventriküler taşikardisi (TdP VT), polimorfik ventriküler taşikardi (PVT) ve ventriküler fibrilasyona neden olabilir. Bu hastalığın kazanılmış formunda; birçok sınıftan bir çok ilaç veya elektrolit dengesizliği sebep olabilir. Bu ilaçlara örnek olarak; grup IA ve III antiaritmikler, makrolid ve kinolon grubu antibiyotikler, antipsikotikler (haloperidol ve fenotiyazin), bazı antiemetikler verilebilir. Elektrolit bozukluğuna örnek olarak da hipopotasemi, hipomagnezemi verilebilir. Biz burada düzeltilmiş QT süresi (dQT): 680 msn olan ve kardiyopulmoner arrest (KPA) gelişen tedaviye dirençli bir hastada aşamalı tedavi yöntemlerini ve erken dönemde koroner sinüsten geçici pil ile atriyal uyarmanın kliniğe olan faydasını anlatacağız. Bu tedavi yöntemine UQTS (özellikle tip 3)'de kullanımıyla ilgili yeni veriler olan meksiletin de dahil edildi. OLGU SUNUMUElli yaşında kadın hastaya romatizmal ileri mitral stenoz ve ileri triküspid yetersizliği nedeniyle 2014 yılının Kasım ayında mitral kapak replasmanı + triküspidde vega operasyonu yapıldı. Hastanın preoperatif ejeksiyon fraksiyonu %45 ve preoperatif QT: 463 msn, QTd: 523 msn olarak hesaplandı. Operasyon sonrası üçüncü gününde KPA gelişen hastaya 10 dakika kardiyopulmoner resüsitasyon (KPR) yapıldı ve VT sebebi olarak diüretiğe sekonder gelişen hipopotasemi düşünüldü. EKG'de QT süresine dikkat edilemeyen hastaya amiodaron infüzyonu, 4 g aralıklı magnezyum sülfat ve potasyum klorür infüzyonu verildi. ÖZETUzamış QT (UQT), bir miyokardiyal repolarizasyon bozukluğu olup QT aralığının uzaması ve taşiaritmilerle karakterizedir. Bu durum; torsades depointes ventriküler taşikardisi (TdPVT), polimorfik ventriküler taşikardi (PVT) ve ventriküler fibrilasyona neden olabilir. Konjenital ve edinsel olmak üzere iki formu mevcuttur. Bu hastalığın edinsel formuna birçok ilaç veya elektrolit dengesizliği sebep olabilir. Edinsel ve konjenital formlarının akut dönemde tedavileri benzerdir. Biz olgu sunumumuzda tedaviye dirençli bir UQT hastasına yapılan; atriyal uyarma, lidokain ve meksiletin gibi güncel tedavi yöntemlerinin başarılı bir şekilde uygulanışını aktarmaya çalıştık.Anahtar Kelimeler: Uzamış QT; atriyal uyarma; meksiletin; amiodaron Prolonged QT with Multiple-Causation and its Succesful Multistage Therapy ABSTRACTProlonged QT (PQT) is a myocardial repolarization disorder characterized by a prolongation of the QT and a propensity to tachyarrhythmias, which may lead to torsades de pointes ventricular tachycardia (TdPVT), polymorphic ventricular tachycardia (PVT), and ventricular fibrillation. There are two forms of the disorder, including congenital and acquired PQT. There are many drugs and electrolyte disturbances that may lead to acquired form of PQT. Treatment of these two types of PQT at acute statement is similar. We report the current succesful therapies consisting of atrial pacing, lidocaine, and mexiletine for a P...

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Amiodarone in Patients with Previous Drug-Mediated Torsade de Pointes

Cited by 91 publications

References 19 publications

Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

Chronic Amiodarone Evokes No Torsade de Pointes Arrhythmias Despite QT Lengthening in an Animal Model of Acquired Long-QT Syndrome

Prolonged QT with Multiple-Causation and its Succesful Multistage Therapy

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