Intravenous amiodarone in intensive care

Hughes, Martin; Binning, A.

doi:10.1007/s001340000668

Cited by 53 publications

(41 citation statements)

References 35 publications

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“…Furthermore, amiodarone has a great effect on ventricular function and it can induce delays in QT time and prolongation of the refractory period by blocking potassium channels (4). Because of amiodarone's effects on the prolongation of the refractory period, it is a choice drug for the treatment of human ventricular and supraventricular tachyarrhythmias (1,4,10,11,14,24). In this study, there was no variation in QRS time, but like in other reports, obvious changes and apparent delays were seen in QT intervals (2).…”

Section: +supporting

confidence: 73%

“…Therefore, it seems that amiodarone is a safe drug and can be used for treatment of feline resistance ventricular and supraventricular tachyarrhythmia (2,4,(9)(10)(11)(12)(13)(14) if proper oral doses are recommended. Our results showed that amiodarone has good effects on heart slowing; therefore, the use of amiodarone in tachyarrhythmia and in slowing the heart rates in patients without cardiac conduction system impairments could be appropriate.…”

Section: +mentioning

confidence: 99%

“…The beneficial effects of amiodarone on the refractory period and the treatment of resistant ventricular arrhythmias were reported (2,(7)(8)(9)(10)(11)(12)(13)(14). Despite the advantages of amiodarone in treatment of different ventricular and supraventricular arrhythmias, its use in veterinary medicine is restricted (4,15).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Amiodarone Effects on Intact Cats? Electrocardiograms (ECG)

GOUYA¹

2013

Turk J Vet Anim Sci

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Section: +supporting

confidence: 73%

Section: +mentioning

confidence: 99%

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Assessment of Amiodarone Effects on Intact Cats? Electrocardiograms (ECG)

GOUYA¹

2013

Turk J Vet Anim Sci

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“…However, pro-arrhythmias including torsades de pointes and ventricular tachycardia were noted in up to 8% of patients. Other short-and long-term adverse events have been extensively reported with the use of anti-arrhythmic agents, particularly amiodarone [12]. Even after successful cardioversion, it may be difficult to maintain sinus rhythm with an increased tendency of recurrence, particularly if the predisposing condition is still present; in our patient, idiopathic dilated cardiomyopathy and hepato-renal dysfunction.…”

Section: Discussionmentioning

confidence: 70%

Role of electrophysiological study and ablation in the management of recurrent atrial flutter associated with haemodynamic compromise in a critically ill patient

Kojodjojo¹,

Kanagaratnam²,

Davies³

et al. 2005

Anaesthesia

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SummaryAtrial flutter is a common arrhythmia. In the critical care setting, the arrhythmia may present in any patient, but it is most commonly seen in patients with impaired ventricular function, valvular disease, atrial dilatation or after cardiac surgery. We present a 68-year-old lady with recurrent poorly tolerated atrial flutter that was resistant to multiple pharmacological interventions and complicated by cardiogenic shock following direct current cardioversion. The flutter was successfully cured with radiofrequency ablation and was followed by an immediate improvement in her haemodynamic status. We review the management of acute atrial flutter and discuss the role of electrophysiologically guided ablation. Atrial flutter is a common arrhythmia in critically ill patients [1]. Whilst direct current cardioversion is extremely effective in terminating acute atrial flutter, it is not curative and the existing treatment paradigm for recurrent atrial flutter, particularly when associated with haemodynamic compromise, is less than ideal. Radiofrequency ablation of atrial flutter is a potentially curative technique with short procedural times, high success and very low complication rates in elective cases, but its application to intensive care patients is not well defined [2,3]. We describe a patient with poorly tolerated atrial flutter for which various treatment strategies were not only ineffective but resulted in clinical deterioration before the flutter was successfully treated by radiofrequency ablation. Case reportA 68-year-old lady was admitted with a 2-month history of intermittent central chest pain, exertional dyspnoea, orthopnoea and peripheral oedema. She had wellcontrolled insulin-treated type 2 diabetes mellitus and hypertension, but no history of ischaemic heart disease.Blood pressure on admission was 105 ⁄ 60 mmHg with a resting tachycardia of 157 beats.min )1. The jugular venous pressure was elevated and mild peripheral oedema was present. A pan-systolic murmur and third heart sound were audible. A chest radiograph revealed cardiomegaly but not overt pulmonary oedema. Blood tests confirmed normal thyroid function, serum electrolytes, liver and renal function tests and blood count. A 12-lead electrocardiogram (ECG) showed a regular narrow-complex tachycardia. Adenosine was administrated with transient atrio-ventricular nodal block, during which the arrhythmia continued, revealing regular flutter waves. Transthoracic echocardiography demonstrated moderate mitral and tricuspid regurgitation with a poorly contracting left ventricle.A working diagnosis of atrial flutter with rate-related symptoms on the background of dilated and severe global cardiac dysfunction was made. Oral metoprolol 25 mg tds was added in an attempt to control her ventricular rate. Intravenous furosemide 80 mg and enoxaparine 150 units.kg )1 were also prescribed. The following day, she remained in atrial flutter with a heart rate of

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“…In addition, class I (Na + channel blockade), II (non-competitive ß-adrenergic blockade) and IV (Ca 2+ channel blockade) properties (3), as well as a reserpine-like sym-patholytic action (4) have been identified in the action of amiodarone. Because of these actions, amiodarone has been widely used for the acute and chronic treatment of ventricular and supraventricular arrhythmia (5)(6)(7). The mechanisms of these antiarrhythmic actions of amiodarone, however, are somewhat complex and are poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Acute effect of amiodarone on cardiovascular reflexes of normotensive and renal hypertensive rats

Oliveira

Silva

Salgado

et al. 2005

Braz J Med Biol Res

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The aim of the present study was to evaluate the effect of amiodarone on mean arterial pressure (MAP), heart rate (HR), baroreflex, BezoldJarisch, and peripheral chemoreflex in normotensive and chronic onekidney, one-clip (1K1C) hypertensive rats (N = 9 to 11 rats in each group). Amiodarone (50 mg/kg, iv) elicited hypotension and bradycardia in normotensive (-10 ± 1 mmHg, -57 ± 6 bpm) and hypertensive rats (-37 ± 7 mmHg, -39 ± 19 bpm). The baroreflex index (∆HR/ ∆MAP) was significantly attenuated by amiodarone in both normotensive (-0.61 ± 0.12 vs -1.47 ± 0.14 bpm/mmHg for reflex bradycardia and -1.15 ± 0.19 vs -2.63 ± 0.26 bpm/mmHg for reflex tachycardia) and hypertensive rats (-0.26 ± 0.05 vs -0.72 ± 0.16 bpm/mmHg for reflex bradycardia and -0.92 ± 0.19 vs -1.51 ± 0.19 bpm/mmHg for reflex tachycardia). The slope of linear regression from ∆pulse interval/∆MAP was attenuated for both reflex bradycardia and tachycardia in normotensive rats (-0.47 ± 0.13 vs -0.94 ± 0.19 ms/mmHg and -0.80 ± 0.13 vs -1.11 ± 0.13 ms/mmHg), but only for reflex bradycardia in hypertensive rats (-0.15 ± 0.02 vs -0.23 ± 0.3 ms/mmHg). In addition, the MAP and HR responses to the Bezold-Jarisch reflex were 20-30% smaller in amiodarone-treated normotensive or hypertensive rats. The bradycardic response to peripheral chemoreflex activation with intravenous potassium cyanide was also attenuated by amiodarone in both normotensive (-30 ± 6 vs -49 ± 8 bpm) and hypertensive rats (-34 ± 13 vs -42 ± 10 bpm). On the basis of the well-known electrophysiological effects of amiodarone, the sinus node might be the responsible for the attenuation of the cardiovascular reflexes found in the present study.

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Intravenous amiodarone in intensive care

Cited by 53 publications

References 35 publications

Assessment of Amiodarone Effects on Intact Cats? Electrocardiograms (ECG)

Assessment of Amiodarone Effects on Intact Cats? Electrocardiograms (ECG)

Role of electrophysiological study and ablation in the management of recurrent atrial flutter associated with haemodynamic compromise in a critically ill patient

Acute effect of amiodarone on cardiovascular reflexes of normotensive and renal hypertensive rats

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