Clinical Study of Amiodarone‐Associated Torsade De Pointes in Chinese People

Geng, Deng-feng; Jin, Dongmei; Wang, Jingfeng; Luo, Ying-Jia; Wu, Wei

doi:10.1111/j.1540-8159.2006.00424.x

Cited by 13 publications

(11 citation statements)

References 7 publications

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“… 9 The mortality has been reported to be between 15 and 21.8% in various studies. 11 , 12 In the present series, none of the patients tested positive for genes of long QT syndrome. In a large series of patients with drug-induced LQT, only 28% tested positive for long QT genes, and these patients could be identified by baseline prolonged QT.…”

Section: Discussionmentioning

confidence: 49%

“… 6 Amiodarone-associated TdP has also been reported increasingly in China. 11 Amiodarone was the most common cause of drug-induced TdP and was implicated in 54% cases in a study from Singapore, and the drug was given intravenously in nearly half of patients. 12 Women appear to be at increased risk of drug-induced TdP in many of the studies.…”

Section: Discussionmentioning

confidence: 99%

“…12 Women appear to be at increased risk of drug-induced TdP in many of the studies. 5 , 10 , 11 Other risk factors include hypokalemia, 11 pretreatment with digoxin, 13 triple therapy with beta-blockers, digoxin, and amiodarone, 14 and left ventricular dysfunction. 15 The hallmark of drug-induced TdP with amiodarone is, prolongation of QTc in patients with normal QTc before initiation, pause dependent onset, polymorphic VT degenerating to VF, and normalization of QTc 48–72 h after drug withdrawal.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of drug-induced torsades de pointes with intravenous amiodarone

Shenthar

Rachaiah

Pillai

et al. 2017

Indian Heart Journal

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AimTo define the incidence, presentation, and outcomes of drug-induced Torsades de Pointes (TdP) with intravenous (IV) amiodarone.MethodsFrom January 2014 to August 2016 a total of 268 patients received IV amiodarone, 142 for ventricular tachycardia, 104 for atrial flutter/fibrillation, and 22 for incessant atrial tachycardia. A uniform dosing of amiodarone to yield 1 gm/day was used in all patients.ResultsFour of the 268 patients (M:F 1:3) with mean age of 51.25 + 9.17 years developed pause dependent TdP degenerating to VF, after a mean dose of 690 + 176.63 mg, infused over 12 + 5.88 h. The QTc that was 505 + 9.02 ms at the time of TdP normalized to 433.75 + 6.13 ms 48–72 h after stopping amiodarone. There was no immediate or late mortality, and patients are well at 5–10 months of follow-up. None of the patients tested positive for LQTS genes.ConclusionThe incidence of drug-induced TdP with IV amiodarone is about 1.5%. Risk factors include female sex, left ventricular dysfunction, electrolyte abnormalities, baseline prolonged QTc, concomitant beta-blocker, and digoxin therapy. Amiodarone induced TdP has favorable prognosis if recognized and treated promptly, and these patients should not receive amiodarone by any route in future.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence of drug-induced torsades de pointes with intravenous amiodarone

Shenthar

Rachaiah

Pillai

et al. 2017

Indian Heart Journal

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“…While intravenous amiodarone is generally regarded as a safe treatment, there are several reports on proarrhythmia inducing TdP under certain conditions including electrolyte imbalance (3,4,6,7). In the present case, incessant monomorphic VT, not TdP, was induced after injection of intravenous amiodarone.…”

Section: Discussionmentioning

confidence: 61%

Incessant Monomorphic Ventricular Tachycardia Induced by the Proarrhythmic Effect of Amiodarone

et al. 2011

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This case report describes incessant monomorphic ventricular tachycardia (VT), not Torsade de Pointes, induced by intravenous amiodarone in a 48-year-old woman with dilated cardiomyopathy. VT was reproducibly triggered by short coupled premature ventricular complex (PVC) with different morphology from VT. After amiodarone infusion, the coupling interval of initiating PVC was prolonged, and moreover, the morphology of initiating PVC became the same as that of VT. Though amiodarone has become the first line drug to treat ventricular tachyarrhythmias in patients with cardiac dysfunction, it is important to be aware of its proarrhythmic effect, which may lead to an electrical storm of monomorphic VT.

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“…In our patient, amiodarone was used to treat premature ventricular contraction and digoxin was used to treat atrial fibrillation and heart failure. Combination therapy comprising digitalis drugs and amiodarone can trigger bradycardia or a pause that can trigger TdP [4]. In addition, digoxin can inhibit the sodium/potassium pump, which can indirectly enhance the sodium/calcium exchanger function, leading to intracellular calcium accumulation and early afterdepolarizations [5].…”

Section: Dear Editormentioning

confidence: 99%