Amiodarone Therapy for Atrial Rhythm Control: Insights Gained From a Single Center Experience

Chandhok, Sheetal; Schwartzman, David

doi:10.1111/j.1540-8167.2007.00847.x

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Antiarrhythmic drugs (AADs) are the most commonly used first-line treatment for AF rhythm control. However, inadvertent use of AADs can increase the mortality (Cardiac-Arrhythmia-Suppression-Trial-(CAST)- Investigators, 1989;The-AFFIRM-Investigators, 2004) and has the risk of various side effects (Chandhok and Schwartzman, 2007). After the establishment of the guidelines of AF management on the use of AADs, the safety of AADs has been improving, and early rhythm control using AADs ensures a better prognosis in AF patients (Kirchhof et al, 2020;Hindricks et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Spatial Changes in the Atrial Fibrillation Wave-Dynamics After Using Antiarrhythmic Drugs: A Computational Modeling Study

et al. 2021

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Background: We previously reported that a computational modeling-guided antiarrhythmic drug (AAD) test was feasible for evaluating multiple AADs in patients with atrial fibrillation (AF). We explored the anti-AF mechanisms of AADs and spatial change in the AF wave-dynamics by a realistic computational model.Methods: We used realistic computational modeling of 25 AF patients (68% male, 59.8 ± 9.8 years old, 32.0% paroxysmal AF) reflecting the anatomy, histology, and electrophysiology of the left atrium (LA) to characterize the effects of five AADs (amiodarone, sotalol, dronedarone, flecainide, and propafenone). We evaluated the spatial change in the AF wave-dynamics by measuring the mean dominant frequency (DF) and its coefficient of variation [dominant frequency-coefficient of variation (DF-COV)] in 10 segments of the LA. The mean DF and DF-COV were compared according to the pulmonary vein (PV) vs. extra-PV, maximal slope of the restitution curves (Smax), and defragmentation of AF.Results: The mean DF decreased after the administration of AADs in the dose dependent manner (p < 0.001). Under AADs, the DF was significantly lower (p < 0.001) and COV-DF higher (p = 0.003) in the PV than extra-PV region. The mean DF was significantly lower at a high Smax (≥1.4) than a lower Smax condition under AADs. During the episodes of AF defragmentation, the mean DF was lower (p < 0.001), but the COV-DF was higher (p < 0.001) than that in those without defragmentation.Conclusions: The DF reduction with AADs is predominant in the PVs and during a high Smax condition and causes AF termination or defragmentation during a lower DF and spatially unstable (higher DF-COV) condition.

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Section: Introductionmentioning

confidence: 99%

Spatial Changes in the Atrial Fibrillation Wave-Dynamics After Using Antiarrhythmic Drugs: A Computational Modeling Study

et al. 2021

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“…13 Only amiodarone and dofetilide are currently considered to be relatively safe in patients with LV dysfunction. 13,14 Moreover, antiarrhythmic agents usually need to be administered long term, and as a result, adverse effects typically develop during the course of treatment. In a recent study only 45% of patients were able to stay on amiodarone for more than 3 years, the other patients discontinued this medication because of the development of adverse effects.…”

Section: Treatment and Managementmentioning

confidence: 99%

“…In a recent study only 45% of patients were able to stay on amiodarone for more than 3 years, the other patients discontinued this medication because of the development of adverse effects. 14 The recommended follow-up for patients who have undergone catheter-based ablation for AF includes electrocardiography, Holter monitoring and CT with pulmonary vein protocol at 3 months after the intervention if patients have no other symptoms or recurrent AF.…”

Section: Treatment and Managementmentioning

confidence: 99%

Cardiomyopathy induced by pulmonary vein tachycardia cured by catheter ablation

2008

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“…6,30 However, amiodarone has several side effects, including corneal microdeposits, hepatic toxicity, thyroid dysfunction, neurotoxicity, coagulopathies, cutaneous reactions, gastrointestinal dysfunction, and pulmonary disease. 4 Lung toxicity is the most potentially serious adverse effect. 30 The incidence of amiodarone lung toxicity (ALT) ranges from 2% to 17% of patients receiving the drug 30 with an estimated mortality rate of 9.1% to 22% of cases of ALT.…”

mentioning

confidence: 99%

Nodular Amiodarone Lung Disease

Ruangchira-urai

Colby

Klein

et al. 2008

American Journal of Surgical Pathology

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The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as an interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic analysis of nodular ALD is available. We report 4 patients with nodular ALD, all of whom had excision of a nodule and none had a preoperative diagnosis of ALD. The radiographic suspicion before excisional biopsy in all 4 cases was malignancy. The initial pathologic suspicion in all 4 cases was either an abscess or vasculitis. In 3 of the 4 cases, where the dosages were known, each patient received 800 mg/d for 7 or more months. All cases have strikingly similar histopathology, with vacuolated histiocytes massed within alveoli to form macroscopic nodules with tissue breakdown. Ultrastructural examination of lung and peripheral nerve in 1 case showed the characteristic inclusions of amiodarone in the cytoplasm of swollen histiocytes. Vacuolated histiocytes filled with these inclusions indicate the effect of the drug, but in these 4 cases there was tissue destruction, which indicated disease. The necrotizing nature of the massed histiocytes in the absence of infection or obstruction suggests the correct etiologic diagnosis even when the history of administration of the drug is not available at initial review.

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Amiodarone Therapy for Atrial Rhythm Control: Insights Gained From a Single Center Experience

Abstract: These data challenge the notion of amiodarone as a reasonable "destination" therapy for AF.

Cited by 4 publications

References 20 publications

Spatial Changes in the Atrial Fibrillation Wave-Dynamics After Using Antiarrhythmic Drugs: A Computational Modeling Study

Spatial Changes in the Atrial Fibrillation Wave-Dynamics After Using Antiarrhythmic Drugs: A Computational Modeling Study

Cardiomyopathy induced by pulmonary vein tachycardia cured by catheter ablation

Nodular Amiodarone Lung Disease

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