Amiodarone: clinical efficacy and toxicity in 96 patients with recurrent, drug-refractory arrhythmias.

Abstract

Ninety-six patients with recurrent, drug-refractory tachyarrhythmias were treated with amiodarone for 8.0 + 7.5 months (range 1 day to 27 months): 77 for recurrent ventricular tachycardia or ventricular fibrillation (VT/VF), two for complex ventricular ectopy, and 17 for supraventricular tachyarrhythmias. The actuarial incidence of successful amiodarone therapy was 52 + 7% at 12 months and 28 + 9% at 24 months for patients with VT/VF. Neither patient with complex ventricular ectopy was successfully treated. Among the patients with supraventricular tachyarrhythmias, 64.7% were successfully treated for 7.7 + 7.6 months (range 1 to 22 months). Amiodarone toxicity occurred in 66 of 91 patients (72.5%) treated for more than 1 week. Fourteen patients had therapy-limiting toxicity. Of these 14, six had pulmonary toxicity, four had arrhythmia exacerbation, one had hepatitis, one had renal toxicity, one had rash, and one had erythema nodosum. The actuarial incidence of therapy-limiting side effects was 27 + 7% at 15 months. We conclude that amiodarone is useful in the treatment of refractory tachyarrhythmias but that the rate of efficacy in VT/VF is lower and the incidence of significant toxicity is higher than has Circulation 68, No. 1, 88-94, 1983.

Evidence-Based Analysis of Amiodarone Efficacy and Safety

“…86,88 The incidence of this complication appears to be low (Ͻ0.5%). Many large follow-up studies have reported no cases, 8,29,31 including the 2 largest (with 462 and 589 patients, respectively). 35,36 Use of programmed electrical stimulation can define a different type of potential proarrhythmic effect of antiarrhythmic drugs.…”

“…Virtually all available publications merely report the outcomes of patients with resuscitated cardiac arrest or recurrent VT treated with amiodarone. [25][26][27][28][29][30][31][32][33][34][35] Most reports conclude that amiodarone is an effective agent, 8,[25][26][27][28][29] although some suggest that amiodarone is not as effective as claimed by early enthusiastic reports. 34 It is not possible to draw any firm conclusions about the efficacy of amiodarone from these uncontrolled reports.…”

Estudo do efeito da amiodarona sobre o peso corpóreo e sobre determinantes morfológicos e citopatológicos do pulmão em ratos machos e fêmeas das linhagens Wistar, Wistar-Kyoto e SHR

“…Embora seja um anti-arrítmico efetivo, provoca diversos efeitos colaterais em 60 a 93% dos indivíduos que fazem uso da droga, tais como depósitos corneanos secundários à pigmentação do epitélio, alterações tireoidianas e hepáticas, insuficiência cardíaca, bradicardia, neurotoxicidade e fibrose pulmonar (2)(3)(4)(5)(6) . Desses, o mais sério é a toxicidade pulmonar, caracterizada por pneumonite intersticial -que ocorre em 5 a 7% dos indivíduos tratados com amiodarona -e que, em geral, evolui para fibrose pulmonar (5)(6)(7)(8)(9) . Acomete predominantemente indivíduos do sexo masculino com mais de 50 anos (5,8) e sua mortalidade está estimada em torno de 5 a 10% dos casos (2,6) .…”

“…Desses, o mais sério é a toxicidade pulmonar, caracterizada por pneumonite intersticial -que ocorre em 5 a 7% dos indivíduos tratados com amiodarona -e que, em geral, evolui para fibrose pulmonar (5)(6)(7)(8)(9) . Acomete predominantemente indivíduos do sexo masculino com mais de 50 anos (5,8) e sua mortalidade está estimada em torno de 5 a 10% dos casos (2,6) .…”

Surgical management of ventricular tachyarrhythmias

“…Serial electrophysiologic testing has improved the ability to select an effective drug, but has also exposed the inadequacies of currently available antiarrhythmic agents. A drug likely to prevent arrhythmia recurrence can be identified in less than 35% of patients with recurrent VTA (Spielman et al, 1983;Swerdlow et al, 1983). Furthermore, a substantial number of patients develop intolerable adverse reactions or worsening of arrhythmias with medical therapy (Fogoros et al, 1983;Velebit et al, 1982).…”