Pharmacological Cardioversion of Atrial Tachyarrhythmias Using Single High-Dose Oral Amiodarone: A Systematic Review and Meta-Analysis

Lei, Lucy Y.; Chew, Derek S.; Lee, William; Meng, Ziran; Erkan, I.; Furlan, Raffaello; Sheldon, Robert S.; Pollak, P. Timothy; Raj, Satish R.

doi:10.1161/circep.121.010321

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…However, the actual risk of hepatoxicity with amiodarone is likely much lower than its feared reputation, as only 2%–4% of patients develop elevated transaminases due to this drug 109–111 . Moreover, a high single oral dose of amiodarone which lacks any hepatotoxicity risk may be considered as an alternative to chronic dosing 112 …”

Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

“…[109][110][111] Moreover, a high single oral dose of amiodarone which lacks any hepatotoxicity risk may be considered as an alternative to chronic dosing. 112 Catheter ablation is an invasive rhythm control option and, based on the most recent data, can be considered first-line therapy or after the failure of anti-arrhythmic drugs. 3,103 Catheter ablation for AF is an invasive procedure that involves venous access from the femoral veins, an atrial transseptal puncture and subsequently circumferential, electrical isolation of the pulmonary veins or so-called pulmonary vein isolation.…”

Section: Rhythm Controlmentioning

confidence: 99%

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Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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Summary Background Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. Aims To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. Methods An extensive literature search was performed using the terms ‘atrial fibrillation’ and ‘cirrhosis’. Guideline documents and consensus statements were explored. Results The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new‐onset AF in the post‐operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre‐transplant and post‐transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. Conclusions Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.

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Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

Section: Rhythm Controlmentioning

confidence: 99%

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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“…A systematic review of several small studies of high-dose oral amiodarone for cardioversion suggests that it is effective. 3 We used this information, guided by measurement of 12hour post-dose amiodarone concentrations, to help address concerns encountered in a patient with atypically high body mass index (BMI), for whom anaesthetic risks excluded electrical cardioversion. Instead, we sought cardioversion using an oral medication that did not require in-hospital monitoring.…”

Section: R Esum Ementioning

confidence: 99%

“…A systematic review of several small studies of high-dose oral amiodarone for cardioversion suggests that it is effective. 3 …”

mentioning

confidence: 99%

Tolerance of High-Dose Oral Amiodarone for Cardioversion of Atrial Flutter

Le¹,

Kavanagh²,

Raj³

et al. 2022

CJC Open

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“…Amiodarone is highly effective, in treating arrhythmias, especially when other treatments are unsuccessful. It has established itself as a component in managing SVTs due to its way of working, and its ability to effectively treat a wide range of arrhythmias [13,15,16].…”

Section: Introductionmentioning

confidence: 99%

Amiodarone and Adenosine for Pediatric Supraventricular Tachycardia: A Systematic Review

Guerra Toro,

Jaramillo,

Caceres

et al. 2023

Cureus

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A review of the literature was made to find and choose research papers, on drugs (amiodarone and adenosine) used for managing supraventricular tachycardia (SVT) in children and infants (one hour to 17 years of age) with no structural heart disease by PRISMA guideline. Our team conducted an exhaustive systematic literature review (SLR), utilizing an extensive search methodology across recognized databases like PubMed, PubMed Central, Google Scholar, Web of Science, and The Cochrane Library. We included 10 scholarly articles that satisfied our rigorous selection criteria including systematic reviews/meta-analysis, and randomized control trials, shedding light on treatment with amiodarone and adenosine for SVT in pediatric patients.There is no first-or second-line treatment for SVT in pediatrics, and drug effectiveness can vary significantly between patients. Adenosine has a shorter half-life than other drugs, instead, it is safer and more valuable when an electrocardiogram is uncertain, it is recommended as an acute management, and it continues as the first-line option for paroxysmal SVT. Amiodarone management patients with acute STV within, its use showed better results when administered 48 hours after diagnosis. Furthermore, it is recommended to reduce the incidence of junctional ectopic tachycardia (JET), by pre-operative prophylaxis, also for chronic control in this and other types of SVT. In none of the evaluated studies were documented significant adverse effects in pediatric patients. Side effects that did occur were mild and easily managed. The studies also emphasize that although both amiodarone and adenosine can successfully convert SVT to sinus rhythm, better results have been observed when using combined therapies of each recommended medication. Therefore, more randomized clinical trials, meta-analyses, and systematic reviews are needed to solidify and possibly standardize an effective and safe pharmacological treatment for SVT and its types in pediatric patients.

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Pharmacological Cardioversion of Atrial Tachyarrhythmias Using Single High-Dose Oral Amiodarone: A Systematic Review and Meta-Analysis

Cited by 4 publications

References 5 publications

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Tolerance of High-Dose Oral Amiodarone for Cardioversion of Atrial Flutter

Amiodarone and Adenosine for Pediatric Supraventricular Tachycardia: A Systematic Review

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