Pro-arrhythmic effects of amiodarone and concomitant rate-control medication

Schrickel, Jan W.; Schwab, Joerg O.; Yang, Alexander; Bielik, H.; Bitzen, Alexander; Lüderitz, Berndt; Lewalter, Thorsten

doi:10.1093/europace/eul038

Cited by 31 publications

(14 citation statements)

References 30 publications

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“…Typical torsade de points tachycardia have been reported shortly after administration of a low dose amiodarone but the rate of such life threatening pro-arrhythmia is comparatively low [29]. Concomitant beta-blocker therapy seems to increase the risk especially in patients with structural heart disease [30]. There were no cases of torsade de pointes or ventricular arrhythmias in our study patients.…”

Section: H Then 900 Mg Over Next 23 H the Protocol Required All Patmentioning

confidence: 48%

Single High Oral Dose Amiodarone for Cardioversion of Recent Onset Atrial Fibrillation

Nadarasa

Williams

2012

Heart, Lung and Circulation

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Section: H Then 900 Mg Over Next 23 H the Protocol Required All Patmentioning

confidence: 48%

Single High Oral Dose Amiodarone for Cardioversion of Recent Onset Atrial Fibrillation

Nadarasa

Williams

2012

Heart, Lung and Circulation

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“…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%

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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“…Proarrhythmic effects of amiodarone and digitalis combination have already been described in case series [4] and small observational studies [5] but no large clinical trial has tackled this important issue yet. Moreover, said evidence is mainly related to ischemic cardiomyopathy and our case is the first to report similar proarrhythmic events in acute left ventricular dysfunction due to a reversible tachycardiomyopathy, without any coronary disease.…”

Section: Discussionmentioning

confidence: 99%

“…The association between amiodarone and TdP may be promoted by concomitant electrolytes imbalance, high drug dosages, or left ventricular dysfunction [2,3] . Amiodarone and digitalis have already been described as an "odd couple", producing TdP and other ventricular arrhythmias, especially in chronic heart failure secondary to coronary heart disease [4,5] . Hereby, we are presenting the first case in which the proarrhythmic effect of this combination is evident in acute non-ischemic ventricular dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Amiodarone and digitalis: An odd couple in a tachycardiomyopathic patient

Guerra

Brambatti²,

Matassini³

et al. 2014

CRIM

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Amiodarone is one of the most used anti-arrhythmic drug for rate and rhythm control in atrial fibrillation. Unfortunately, it has also well-known pro-arrhythmic properties and it has been reported as a common cause of malignant ventricular tachyarrhytmias, especially torsade de pointes. Proarrhytmic effects of amiodarone are greatly increased by other concomitant factors, such as ventricular dysfunction and concomitant treatment with digitalis. Current evidence shows how amiodarone and digitalis together are associated with torsade de pointes in ischemic patients with heart failure. The present case report describes, for the first time, how amiodarone and digital can concur in producing torsade de pointes also in a tachycardiomyopathic patient with no coronary artery disease.

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Pro-arrhythmic effects of amiodarone and concomitant rate-control medication

Abstract: The present study implies that initiation of amiodarone therapy in pts with structural heart disease and AF that are concomitantly treated with beta-blockers and digitalis may have an increased risk of amiodarone-associated pro-arrhythmia.

Cited by 31 publications

References 30 publications

Single High Oral Dose Amiodarone for Cardioversion of Recent Onset Atrial Fibrillation

Single High Oral Dose Amiodarone for Cardioversion of Recent Onset Atrial Fibrillation

Incidence of drug-induced torsades de pointes with intravenous amiodarone

Amiodarone and digitalis: An odd couple in a tachycardiomyopathic patient

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