Efficacy and Safety of Low-Dose Amiodarone Therapy for Tachyarrhythmia in Congenital Heart Disease

Shah

J Innov Cardiac Rhythm Manage

et al. 2020

Amiodarone is commonly used for a variety of arrhythmias and, in some parts of the world, is the only available antiarrhythmic drug (AAD). Yet, amiodarone is known to have a wide range of potential side effects, many of which are dose-and duration-dependent. We sought to study the incidence of side effects leading to the discontinuation of low-dose amiodarone, arbitrarily defined as 200 mg/day or less, and very-low-dose amiodarone, defined as 100 mg/ day or less. In this study, literature databases were searched through June 2019. Studies that reported the incidence or prevalence of side effects of amiodarone were included. Effect estimates from individual studies were extracted and combined using the random-effects generic inverse variance method of DerSimonian and Laird. A total of 10 observational cohort studies involving 901 patients were included in the analysis. The pooled estimated incidence of overall side effects for low-dose amiodarone was 0.17 [95% confidence interval (CI): 0.12-0.22]. In addition, the pooled estimated incidence of side effects requiring medication discontinuation was 0.06 (95% CI: 0.03-0.11). As compared with 200 mg/day of amiodarone, the pooled estimated incidence of overall side effects was 0.11 (95% CI: 0.04-0.27), while the incidence of side effects requiring medication discontinuation was 0.02 (95% CI: 0.01-0.06) for the dose of 100 mg/day. In conclusion, verylow-dose amiodarone displays a low incidence of significant side effects requiring medication discontinuation.

Section: Resultsmentioning

confidence: 99%

Low-dose Amiodarone Is Safe: A Systematic Review and Meta-analysis

Shah

J Innov Cardiac Rhythm Manage

et al. 2020

Heart, Lung and Circulation

“…Several studies have shown an increased incidence (up to 30%) of amiodarone-induced thyrotoxicosis in adults with CHD, with patients with a Fontan circulation being at highest risk [198,199]. However, other studies have found amiodarone to be safe at lower doses and if patients with low body mass index are excluded [200,201].…”

Section: Medical Therapymentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

“…Adjunctive medications with known benefits, such as arrhythmia prevention [ 121 ], symptom reduction [ 122 ], mitigation of neurohormonal activation [ 50 ], and closure of the patent ductus arteriosus in treating CHDs [ 123 ], are reported for angiotensin receptor-neprilysin inhibitors (ARNIs) [ 103 , 124 ], antiarrhythmics [ 125 ], digoxin [ 126 ], and non-steroidal anti-inflammatory drugs (NSAIDs) [ 127 ].…”

Section: Drugs For Chd Treatmentmentioning

confidence: 99%

Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics

Varela-Chinchilla

Sánchez-Mejía

Trinidad-Calderón

2022

JCDD

Congenital heart disease is one of the most common causes of death derived from malformations. Historically, its treatment has depended on timely diagnosis and early pharmacological and surgical interventions. Survival rates for patients with this disease have increased, primarily due to advancements in therapeutic choices, but mortality remains high. Since this disease is a time-sensitive pathology, pharmacological interventions are needed to improve clinical outcomes. Therefore, we analyzed the applications, dosage, and side effects of drugs currently used for treating congenital heart disease. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and potassium-sparing diuretics have shown a mortality benefit in most patients. Other therapies, such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostaglandins, and soluble guanylyl cyclase stimulators, have benefited patients with pulmonary artery hypertension. Likewise, the adjunctive symptomatic treatment of these patients has further improved the outcomes, since antiarrhythmics, digoxin, and non-steroidal anti-inflammatory drugs have shown their benefits in these cases. Conclusively, these drugs also carry the risk of troublesome adverse effects, such as electrolyte imbalances and hemodynamic compromise. However, their benefits for survival, symptom improvement, and stabilization outweigh the possible complications from their use. Thus, cases must be assessed individually to accurately identify interventions that would be most beneficial for patients.