Amiodarone versus other pharmacological interventions for prevention of sudden cardiac death

Claro, Juan Carlos; Cândia, Roberto; Rada, Gabriel; Baraona, Fernando; Larrondo, Francisco Javier Ocharan; Letelier, Luz María

doi:10.1002/14651858.cd008093.pub2

Cited by 29 publications

(26 citation statements)

References 92 publications

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“…Amiodarone is a class III antiarrhythmic agent approved by the US Food and Drug Administration (FDA) for the medical management of life-threatening cardiac arrhythmias, and may serve as an alternative to implantable cardioverter defibrillator (ICD) for prophylaxis of sudden cardiac death (SCD) in patients with left ventricular (LV) dysfunction [1,2]. The drug molecule is unique with a very long plasma half-life, and toxicity is common with diverse organ dysfunctions even after several months of commencement and/or discontinuation of treatment.…”

Section: Introductionmentioning

confidence: 99%

Amiodarone-Induced Thyroid Dysfunction: A Clinical Update

Elnaggar

Jbeili

Nik-Hussin

et al. 2018

Exp Clin Endocrinol Diabetes

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Amiodarone is one of the most commonly prescribed antiarrhythmic agents in clinical practice owing to its efficacy, even with high toxicity profile. The high iodine content and the prolonged biological half-life of the drug can result in thyroid dysfunction in a high proportion of patients treated with amiodarone even after cessation of amiodarone. Both hypothyroidism and hyperthyroidism are common side effects that mandate regular monitoring of patients with thyroid function tests. Amiodarone-induced hypothyroidism (AIH) is diagnosed and managed in the same way as a usual case of hypothyroidism. However, differential diagnosis and clinical management of amiodarone-induced thyrotoxicosis (AIT) subtypes can be challenging. With the aid of a case snippet, we update the current evidence for the diagnostic work up and management of patients with amiodarone-induced thyroid dysfunction in this article.

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Section: Introductionmentioning

confidence: 99%

Amiodarone-Induced Thyroid Dysfunction: A Clinical Update

Elnaggar

Jbeili

Nik-Hussin

et al. 2018

Exp Clin Endocrinol Diabetes

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“…Compared to placebo/control, there was a 29 and 18% reduction in sudden death and cardiovascular mortality, respectively [ 35 ]. Moreover, in a recent meta-analysis of primary prevention, amiodarone reduced the risk of sudden cardiac death by 34% [ 14 ]. In the absence of direct evidence for patients with Chagas cardiomyopathy, these figures may provide an indirect estimate of the potential benefit in our population of interest.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies that did not include Chagas patients suggested that adverse effects are common, with a prevalence as high as 15% in the first year of use and 50% during long-term use, indicating a cumulative effect with chronic use, corroborating our results [ 36 ]. Moreover, in an additional study, the risk of discontinuation of amiodarone was 45% superior than placebo, however presenting similar rates when compared with other antiarrhythmics [ 14 ]. Of note, even though our review found that amiodarone was associated with a low incidence of sinus bradycardia (7%), concomitant use of amiodarone and beta-blockers in Chagas cardiomyopathy may increase the risk of exacerbation of bradyarrhythmia [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a recent meta-analysis of primary prevention (17 studies, 8383 participants), amiodarone reduced sudden death, cardiac mortality and all-cause mortality; however, Chagas patients were not included. Nevertheless, amiodarone was associated with increased adverse effects, both hypo- or hyperthyroidism and pulmonary fibrosis, and increased risk of discontinuation compared with placebo [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Amiodarone for arrhythmia in patients with Chagas disease: A systematic review and individual patient data meta-analysis

et al. 2018

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BackgroundChagas disease is a neglected chronic condition caused by Trypanosoma cruzi, with high prevalence and burden in Latin America. Ventricular arrhythmias are common in patients with Chagas cardiomyopathy, and amiodarone has been widely used for this purpose. The aim of our study was to assess the effect of amiodarone in patients with Chagas cardiomyopathy.MethodologyWe searched MEDLINE, Embase and LILACS up to January 2018. Data from randomized and observational studies evaluating amiodarone use in Chagas cardiomyopathy were included. Two reviewers selected the studies, extracted data and assessed risk of bias. Overall quality of evidence was accessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).Principal findingsWe included 9 studies (3 before-after studies, 5 case series and 1 randomized controlled trial). Two studies with a total of 38 patients had the full dataset, allowing individual patient data (IPD) analysis. In 24-hour Holter, amiodarone reduced the number of ventricular tachycardia episodes in 99.9% (95%CI 99.8%-100%), ventricular premature beats in 93.1% (95%CI 82%-97.4%) and the incidence of ventricular couplets in 79% (RR 0.21, 95%CI 0.11–0.39). Studies not included in the IPD analysis showed a reduction of ventricular premature beats (5 studies), ventricular tachycardia (6 studies) and ventricular couplets (1 study). We pooled the incidence of adverse side effects with random effects meta-analysis; amiodarone was associated with corneal microdeposits (61.1%, 95%CI 19.0–91.3, 5 studies), gastrointestinal events (16.1%, 95%CI 6.61–34.2, 3 studies), sinus bradycardia (12.7%, 95%CI 3.71–35.5, 6 studies), dermatological events (10.6%, 95%CI 4.77–21.9, 3 studies) and drug discontinuation (7.68%, 95%CI 4.17–13.7, 5 studies). Quality of evidence ranged from moderate to very low.ConclusionsAmiodarone is effective in reducing ventricular arrhythmias, but there is no evidence for hard endpoints (sudden death, hospitalization). Although our findings support the use of amiodarone, it is important to balance the potential benefits and harms at the individual level for decision-making.

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“…Применение амиодарона не ассоциируется с повышенной смертностью, в том числе у пациентов с выраженными структурными изменениями сердца [5], а в недавно проведенном мета-анализе 24-х рандо-мизированных и псевдорандомизированных иссле-дований (n=9997) было сделано заключение о нали-чии доказательств низкого/умеренного качества, под-тверждающих способность амиодарона снижать вне-запную сердечную смерть, а также смертность от всех причин и сердечно-сосудистых причин [6]. Однако при-менение амиодарона у пациентов пожилого возраста ограничивают его побочные эффекты и клинически значимые последствия лекарственных взаимодей-ствий.…”

Section: Antiarrhythmic Drugs In Elderly Patientsunclassified