Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias

Abstract

Sufficient rate control can be achieved in critically ill patients with atrial tachyarrhythmias using either diltiazem or amiodarone. Although diltiazem allowed for significantly better 24-hr heart rate control, this effect was offset by a significantly higher incidence of hypotension requiring discontinuation of the drug. Amiodarone may be an alternative in patients with severe hemodynamic compromise.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…U pacjentów z HFrEF należy stosować beta-adrenolityki, preparaty naparstnicy (digoksynę lub digitoksynę) bądź ich skojarzenia [218,533], ponieważ diltiazem i werapamil mogą wywierać ujemne działanie inotropowe u pacjentów z LVEF < 40% [222,534,535]. U pacjentów w krytycznie ciężkim stanie oraz tych ze znacznie zaburzoną czynnością skurczową lewej komory można stosować amiodaron dożylnie, jeżeli zbyt szybka czynność komór prowadzi do niestabilności hemodynamicznej [536][537][538]. U pacjentów w niestabilnym stanie klinicznym należy rozważyć pilną kardiowersję (patrz rozdz.…”

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

“…b-blocker (BB) and calcium channel blocker (CCB) medications may be used to slow atrioventricular nodal conduction and lower supraphysiologic heart rates but may also exacerbate hypotension among patients with distributive states such as septic shock. 13 Cardiac glycosides (digoxin) may be selected to reduce heart rates without inducing hypotension but may be less effective in high catecholamine states 14 and have low therapeutic index in the setting of renal dysfunction, which is commonly encountered during sepsis. 15 Amiodarone may be selected as a rate-or rhythm-controlling agent for AF during critical illnesses such as sepsis, 11 but it also presents risks for proarrhythmia, drug interactions, and multiple organ toxicities.…”

“…15 Amiodarone may be selected as a rate-or rhythm-controlling agent for AF during critical illnesses such as sepsis, 11 but it also presents risks for proarrhythmia, drug interactions, and multiple organ toxicities. 13,16 To inform current knowledge gaps regarding AF treatment during critical illness, 17 we sought to identify current clinical practice patterns and compare effectiveness between treatment strategies for AF among a large cohort of patients hospitalized with sepsis. We aimed to determine hospital-level variation in choice of initial AF therapy to explore our hypothesis that choice of treatment of AF during sepsis is subject to wide practice pattern variation.…”

Optimizing Atrial Fibrillation Management

“…Amiodarone may slow nodal conduction and have antiarrhythmic eff ects resulting in cardioversion but also presents risks for proarrhythmic eff ects, drug interactions, and organ toxicities. 17,18 Amiodarone infusion may also be associated with hypotension and reduced cardiac output, especially among patients with concurrent cardiovascular disease, an eff ect that may be related to its cosolvents. 19,20 Only small, single-center studies have compared the eff ectiveness of selected AF therapies in critically ill patients.…”