Efficacy, Safety, and Determinants of Conversion of Atrial Fibrillation and Flutter With Oral Amiodarone

Tieleman, RG; Gosselink, A T Marcel; Crijns, H. J. G. M.; Gelder, I. C. Van; Berg, Monika; Kam, P.J. de; Gilst, W. H. Van; Lie, Ki

doi:10.1016/s0002-9149(96)00675-3

Cited by 107 publications

(60 citation statements)

References 30 publications

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“…This may be related to a high myocardium/ plasma concentration ratio in the case of desethylamiodarone. In contrast, reduction of the ventricular rate during ongoing atrial fibrillation was clearly correlated with plasma levels of amiodarone itself 56 . The long delay between initiation of therapy and the onset of action remains a serious problem because with conventional loading regimens, mean delays of 9.5 days have been reported 57 .…”

Section: Oral Administrationmentioning

confidence: 87%

Therapeutic monitoring of amiodarone: pharmacokinetics and evaluation of the relationship between effect and dose/concentration

Vyskocilova¹,

Grundmann²,

Kacířová³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Amiodarone is the most effective agent in the therapy of arrhythmias. However, the clinical effect of acute and chronic treatment is unclear and there are differences irrespective of comparable plasma/myocardial amiodarone and its metabolite desethylamiodarone concentations as well. Its unusual pharmacokinetics results in interindividual variation in plasma levels. The association between amiodarone and desethylamiodarone plasma levels and clinical efficacy is difficult to evaluate. This review was carried out to assess whether there is any objective correlation between amiodarone and desethylamiodarone plasma levels and the clinical effect. We summarized the results of relevant studies and clarified the relationship between plasma levels and effect vis á vis the pharmacokinetics and pharmacogenetics of this drug. Certain correlation was seen with oral amiodarone therapy, in others, plasma amiodarone levels were unrelated to therapeutic response and showed no correlation with changes in electrocardiogram or electrophysiological parametres. Several studies show that plasma concentration ranging between 0.5 and 2.5 mg/L appears to be the most effective, others demonstrate no difference between responders and non-responders. One way of interpreting plasma levels is to establish an individual patient´s effective concentration. Therapeutic drug monitoring can contribute to determining optimal concentration.

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Section: Oral Administrationmentioning

confidence: 87%

Therapeutic monitoring of amiodarone: pharmacokinetics and evaluation of the relationship between effect and dose/concentration

Vyskocilova¹,

Grundmann²,

Kacířová³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Major variables earlier described to determine pharmacological or electrical cardioversion success are arrhythmia type and duration, ejection fraction and atrial enlargement (Tieleman et al 1997). Age seems to be of minor importance (Gold et al 1986).…”

Section: Discussionmentioning

confidence: 99%

“…The delay was more than three days. Tieleman et al (1997) used 600 mg/day orally on a group of patients with chronic atrial fibrillation or atrial flutter. Arrhytmia duration median was 53 months, range 1-348 months.…”

Section: Discussionmentioning

confidence: 99%

“…Supraventricular arrhythmia such as atrial fibrillation, atrial flutter and atrial tachycardia is widely treated by electrical cardioversion under general anaesthesia (van Gelder & Crijns 1997).…”

mentioning

confidence: 99%

“…Only arrhythmia of short duration of less than 12 months has therefore been subject to treatment with cardioversion. Recent research has shown improved results of pharmacological treatment of long-lasting atrial tachyarrhythmia, and there is now a tendency towards a more intensified treatment of patients with much longer duration of arrhythmia (van Gelder & Crijns 1997).…”

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confidence: 99%

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Amiodarone for Rapid Cardioversion of Chronic Atrial Tachyarrhythmia?

Nielsen

Möller

2000

Pharmacology & Toxicology

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Electrical cardioversion of atrial tachyarrhythmia has disadvantages, such as the need for general anaesthesia, skin burns and thoracic pain. Pharmacodynamic cardioversion is without these side effects, but the reports of the efficacy of the treatment vary a lot. Amiodarone has been the only drug so far reported to give a combination of high efficacy and low frequency of serious side effects such as ventricular tachycardia and shock. The purpose of the present study was to assess the effect of amiodarone on chronic atrial tachycardia. Seventeen patients with chronic atrial fibrillation or flutter were given an oral dose of 30 mg/kg amiodarone. Serial blood tests after amiodarone ingestion were taken to document absorption. Patients, who did not convert to sinus rhythm within 24 hr were treated by electrical cardioversion. No patients converted pharmacodynamically to sinus rhythm. Twelve patients (71%) reached the recommended serum concentration of amiodarone (2-2.5 mg/l, median 2.4 mg/l, range 0.96-4.7). The concentration of desethylamiodarone remained low (Ͻ0.2 mg/l), and there were no objective or subjective side effects following the treatment. Sixteen patients (94%) were converted to sinusrhythm the day after by electrical cardioversion without complications. A single high dose of amiodarone is a safe but ineffective method of converting chronic atrial fibrillation and flutter, and may be used as adjuvant therapy in combination with electrical cardioversion.

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Continuous vs Episodic Prophylactic Treatment With Amiodarone for the Prevention of Atrial Fibrillation

Ahmed¹,

Rienstra²,

Crijns³

et al. 2008

JAMA

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It may cause symptoms, heart failure, and stroke. 1 Recent studies have established that morbidity and mortality are comparable between rate-and rhythm-control therapy. 2-5 However, long-term maintenance of sinus rhythm provides a variety of benefits, including an improvement in cardiac function and quality of life. 6-8 Therefore, maintenance of sinus rhythm is still the treatment of choice in symptomatic patients, those with tachycardiomyopathy, and when adequate rate control cannot be achieved. 3 However, success of pharmacological rhythm control is rather limited. 3,9 With a serial antiarrhythmic drug approach, no more than 40% of the patients are in sinus rhythm after a year and only about 30% after 4 years. 9 Of all class I, II, and III antiarrhythmic drugs, amiodarone is the most effective antiarrhythmic drug in preventing atrial fibrillation. 10-13 Amioda-rone maintains sinus rhythm in 45% to 70% of the patients during 12 to 54 months of follow-up. 11 Unfortunately, amiodarone causes many (noncardiac) adverse events, which are mostly Author Affiliations and a List of the CONVERT Investigators are listed at the end of this article.

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Efficacy, Safety, and Determinants of Conversion of Atrial Fibrillation and Flutter With Oral Amiodarone

Abstract: Efficacy, safety, and determinants of conversion of atrial fibrillation and flutter with oral amiodarone Tieleman, R.G.; Gosselink, A.T.; Crijns, H.J.G.M.; van Gelder, I.C.; van den Berg, M.P.; de Kam, P.J.; van Gilst, W.H.; Lie, K.I.

Cited by 107 publications

References 30 publications

Therapeutic monitoring of amiodarone: pharmacokinetics and evaluation of the relationship between effect and dose/concentration

Therapeutic monitoring of amiodarone: pharmacokinetics and evaluation of the relationship between effect and dose/concentration

Amiodarone for Rapid Cardioversion of Chronic Atrial Tachyarrhythmia?

Continuous vs Episodic Prophylactic Treatment With Amiodarone for the Prevention of Atrial Fibrillation

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