Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department ...Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department of Cardiology of our hospital between August 2022 and August 2023 were selected as research subjects.They were divided into two groups using the coin-tossing method:the combination group(n=35)and the reference group(n=35).The combination group was treated with low-dose Betaloc and amiodarone,and the control group was treated with low-dose Betaloc alone.The treatment efficacy,cardiac function indicators,and related tested indicators of the two groups were compared.Results:The total efficacy of the treatment received by the combination group was much higher than that of the control group(P<0.05).Besides,after treatment,the cardiac function indicators such as left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and cardiac index(CI)of the patients in the combination group were significantly better than those of the reference group(P<0.05).Furthermore,the high-sensitivity C-reactive protein(Hs-CRP),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),adiponectin(APN),and other related test indicators of the patients in the combination group were significantly better than those of the reference group(P<0.05).Conclusion:Low-dose Betaloc combined with amiodarone has a noticeable effect in treating ventricular arrhythmia and deserves to be widely promoted.展开更多
Warfarin has been used as anticoagulant for the long-term treatment of thromboembolic disease, however, the wide spread use is limited by a wide inter-individual variation in dose requirement. Recent studies have demo...Warfarin has been used as anticoagulant for the long-term treatment of thromboembolic disease, however, the wide spread use is limited by a wide inter-individual variation in dose requirement. Recent studies have demonstrated that amiodarone may interact with warfarin to potentiate the anticoagulant effects and lead to an elevated international normalized ratio（INR）. In addition, genetic variation in the vitamin K epoxide reductase complex subunit 1（VKORC1） and cytochrome P450 2C9（CYP2C9） may also affect the dose of warfarin in single or combination therapy. In our study, we aim to examine the effect of amiodarone on the warfarin in different CYP2C9 and VKORC1 status. From September 2008 to November 2009, 207 patients from Beijing, China were enrolled in our study, including 34 patients on combination therapy of amiodarone and warfarin and 173 patients on warfarin therapy. VKORCl and CYP2C9 genotypes were examined using ligation detection reaction（LDR） method. We compared the stable dosage of warfarin and INR between patients on warfarin therapy and patients on warfarin-amiodarone therapy when they are stratified with VKORC1 or CYP2C9 genotype. We did not observe significant difference in dosage or INR between these two groups. The difference in characteristics between these two groups, the blood collection time after amiodarone administration and the method for monitoring may all contribute to the negative finding. Large studies taking into account of these factors are needed to improve our understanding of the interaction between warfarin and amiodarone, as well as the effect of genotype in such interaction.展开更多
Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug re...Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug reactions—because of changes in pharmacodynamics,concurrent use of multiple medications and the related drug interactions.However,adverse drug reactions are significantly underestimated in the elderly population that is also exposed to inappropriate drugs.Amiodarone is an antiarrhythmic drug used commonly for the treatment of atrial fibrillation and is increasingly prescribed in older people.While amiodarone is an efficient drug for rhythm control,it’s a carrier of different adverse reactions,and pro and cons must be carefully evaluated before its use especially in older people.展开更多
BACKGROUND：Amiodarone is a useful antiarrhythmic drug.Phlebitis,caused by intravenous amiodarone,is common in patients in coronary care units（CCUs）.OBJECTIVE：The aim of this study was to evaluate the effect of top...BACKGROUND：Amiodarone is a useful antiarrhythmic drug.Phlebitis,caused by intravenous amiodarone,is common in patients in coronary care units（CCUs）.OBJECTIVE：The aim of this study was to evaluate the effect of topical chamomile on the incidence of phlebitis due to the administration of an amiodarone infusion into the peripheral vein.DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS：This was a randomized,double-blind clinical trial,conducted on 40 patients（n=20 per group）in two groups—an intervention group（chamomile ointment）and a control group（lanoline,as a placebo）,hospitalized in the CCUs and undergoing an amiodarone infusion into the peripheral vein over 24 h.Following the cannulation and commencement of the infusion,placebo or chamomile ointment was rubbed in,up to 10 cm superior to the catheter and repeated every eight hours for three days.The cannula site was then assessed based on the phlebitis checklist.MAIN OUTCOME MEASURES：The incidence and time of occurrence of phlebitis,relative risk,severity of phlebitis were the main outcome measures.RESULTS：Nineteen patients（19/20）in the control group had phlebitis on the first day of the study and one patient（20/20）on the second day.In the intervention group,phlebitis occurred in 13 cases（13/20）on the first day and another two（2/7）was found on the second day.The incidence of phlebitis was significantly different between two groups（P=0.023）.The cumulative incidence of phlebitis in the intervention group（15/20）is significantly later and lower than that in the control group（20/20）during two days（P=0.008）.Two patients in the intervention group did not develop phlebitis at all during the 3-day study.Also,the relative risk of phlebitis in the two groups was 0.68（P=0.008 5）.A significant difference was not observed with regard to phlebitis severity in both groups.CONCLUSION：It seems that phlebitis occurred to a lesser extent and at a later time frame in the intervention group compared to control group.Topical chamomile may be effective in decreasing the incidence of phlebitis due to an amiodarone infusion.展开更多
Summary： To study the effect of of lidocaine and amiodarone on the transmural heterogeneity of ventricular repolarization in isolated rabbit hearts model of sustained global ischemia and to explore the mechanisms und...Summary： To study the effect of of lidocaine and amiodarone on the transmural heterogeneity of ventricular repolarization in isolated rabbit hearts model of sustained global ischemia and to explore the mechanisms underlying the antiarrhythmic activity of lidocaine and amiodarone, rabbits were randomly divided into 4 groups： control group, ischemia group, lidocaine group and amiodarone group. By the monophasic action potential （MAP） recording technique, MAPs of epicardium, midmyocardium and endocardium were simultaneously recorded across the left ventricular free wall in rabbit hearts perfused by low-flow ischemia （2. 5 mL/min） in Langendorff method to study the transmural dispcrsion of repolarization （TDR） and arrhythmic induced by ischemia.Our results showed that TDR of three myocardial layers in ischemia group were significantly lengthened after ischemia. TDR was increased from 17.5±3.9 ms to 31.2±4.6 ms at the time that concided with the onset of sustained ventricle arrhythmic. Amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia, and no significant difference was found at other ischemia time points. 5 cases had ventriclar arrhythmia in ischemia group （62. 5%）, but no case in lidocaine group （P〈0.01） and only 1 case in amiodarone group had ventrilar arrhythmia （P〈 0.01）. No significant difference was found between amiodarone group and lidocaine group. It is concluded that TDR of of three myocardial layers increases significantly at ischemia and it is closely associated with development of ventricular arrhythmia, and amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia and has no effects at other ischemia time points.展开更多
We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the...We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the pathogenesis of IV amiodaroneDILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality.Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.展开更多
The anti-arrhythmic agent amiodarone （AD） is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established a...The anti-arrhythmic agent amiodarone （AD） is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established and this regimen is used for long-term medication. Nevertheless, asymptomatic continuous liver injury by AD may increase the risk of step-wise progression of non-alcoholic fatty liver disease. We present an autopsy case of AD-induced liver cirrhosis in a patient who had been treated with a low dose of AD （200 rag/d） daily for 84 too. The patient was a 85-year-old male with a history of ischemic heart disease. Seven years after initiation of treatment with AD, he was admitted with cardiac congestion. The total dose of AD was 528 g. Mild elevation of serum aminotransferase and hepatomegaly were present. Liver biopsy specimens revealed cirrhosis, and under electron microscopy numerous lysosomes with electron-dense, whorled, lamellar inclusions characteristic of a secondary phospholipidosis were observed. Initially, withdrawal of AD led to a slight improvement of serum aminotransferase levels, but unfortunately his general condition deteriorated and he died from complications of pneumonia and renal failure. Long-term administration of daily low doses of AD carries the risk of progression to irreversible liver injury. Therefore, periodic examination of liver function and/or liver biopsy is required for the management of patients receiving long-term treatment with AD.展开更多
Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in ...Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in less than 1% to 3% of patients taking amiodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity. A 29 year old woman with normal liver function was given amiodarone intravenously to treat her atrial fibrillation. She developed acute toxic hepatitis after 24 h. The intravenous form of amiodarone was immediately avoided and replaced by the oral form, using conventional loading doses as soon as the deranged liver function tests had normalized, without recurrence of the hepatitis. These observations show that the occurrence of acute hepatic impairment with intravenous amiodarone does not necessarily preclude the use of this drug by mouth and the necessity of monitoring the hepatic function of patients treated with amiodarone.展开更多
Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-...Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.展开更多
Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats.Methods:Animals were divided into four groups.Group ...Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats.Methods:Animals were divided into four groups.Group I was considered as control.Group II was given grapefruit juice at a dose level of 27 mL/kg body weight.Group III was orally administered amiodarone(18 mg/kg body weight)daily for 5 weeks.Animals were sacrificed after 5 weeks of treatment.Bone marrow was collected from the femurs for analysis of chromosomal aberrations and mitotic indices.Testes were removed and stained with H&E for histological examination.Sperms were collected from epidedymis for detection of sperm head abnormalities.Comet assay was used to detect DNA damage.Results:Amiodarone treatment caused a significant increase in the percentage of chromosomal aberrations,decreased the mitotic index and increased DNA damage.The testis showed many histopathological alterations,inhibition of spermatogenesis and morphometric changes.The number of sperm head abnormalities was increased.Treating animals with amiodarone and grapefruit juice caused a reduction in chromosomal aberrations,mitotic index,DNA damage and testicular alterations caused by amiodarone.Conclusions:The results of this study indicated that grapefruit juice ameliorates the cytotoxicty and testicular alterations induced by amiodarone in albino rats and this is may be due to the potent antioxidant effects of its components.展开更多
Amiodarone, a class Ⅲ antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary to...Amiodarone, a class Ⅲ antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodarone-induced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.展开更多
BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-in...BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-induced hepatotoxicity in patients on long-term oral amiodarone therapy who underwent dual-energy computed tomography(DECT).CASE SUMMARY We report the clinical and iodine density in the liver using DECT in three patients with amiodarone-induced hepatotoxicity.Liver enzymes were increased in these three patients,and abdominal DECT without contrast medium showed highly increased attenuation in the liver.Furthermore,the iodine concentration in the liver was increased.The first patient with amiodarone-induced reversible hepatotoxicity,showed a reversible course of liver function and a decrease in CT values after discontinuation of amiodarone.The second patient on long-term oral amiodarone had increased iodine concentration in the liver and liver damage,the patient eventually developed rapidly progressive pneumonia and died of multiple organ failure.The third patient,showed an increased iodine concentration in the liver and elevated liver enzymes.However,the patient refused radiofrequency ablation for atrial fibrillation and continued oral amiodarone to control atrial fibrillation,and routine liver function tests were required every 3-6 mo in this patient.CONCLUSION DECT is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.展开更多
Amiodarone hydrochloride is a potent anti-arrhythmic agent, known as a multiple ion-channel blocker in the heart. Although it has been detected in the rat brain, there are no data related to its central nervous system...Amiodarone hydrochloride is a potent anti-arrhythmic agent, known as a multiple ion-channel blocker in the heart. Although it has been detected in the rat brain, there are no data related to its central nervous system （CNS） effects. In this study, we evaluated anticonvulsant and hypnotic effects of amiodarone. Convulsions were induced by phentylenetetrazole （PTZ） （100 mg/kg） or caffeine （300 mg/kg） in mice. In both models, amiodarone prolonged both latency period and time to death, and acted as an anticonvulsant drug. It was found to be more effective in the PTZ model than in the caffeine model; none of the animals treated with 150 mg/kg dose amiodarone had died in the PTZ model. For hypnotic effect, sleeping was induced with pentobarbital （35 mg/kg） in rats. Amiodarone dose-dependently increased the sleeping time （677.7%-725.9%）. In the sleeping test, all rats in 200 mg/kg amiodarone group died. In conclusion, anticonvulsant and hypnotic effects of amiodarone have shown the depressant effects on CNS. These effects may be dependent on its pharmacological properties.展开更多
BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with...BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with a palpable gallbladder was investigated clinically,radiologically endoscopically and via liver biopsy. RESULTS:Liver biopsy showed amiodarone hepatotoxicity Endoscopic biopsy identified an ampullary adenoma However,the endoscopic ultrasound and intra-operative findings suggested a malignancy,which was confirmed postoperatively. CONCLUSIONS:While the classic findings of Courvoisier’s Law are borne out in this case,the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.展开更多
BACKGROUND Amiodarone is a Class III antiarrhythmic drug,which has been adopted for the treatment of atrial fibrillation and ventricular arrhythmia.However,the use of amiodarone can cause lower limb muscle tremors,whi...BACKGROUND Amiodarone is a Class III antiarrhythmic drug,which has been adopted for the treatment of atrial fibrillation and ventricular arrhythmia.However,the use of amiodarone can cause lower limb muscle tremors,which is recognized as a rare side effect of this medication.CASE SUMMARY An 84-year-old female was administrated with amiodarone for paroxysmal supraventricular tachycardia and frequent ventricular tachycardia.The patient developed a bilateral gastrocnemius tremor in the course of medication,and the strength of the patient’s bilateral knee flexor and extensor reached 4/5 and 3/5,respectively.After the use of amiodarone was stopped,and the patient was given a small dose of levetiracetam,the lower limb tremor symptoms were significantly mitigated,along with activity and function.CONCLUSION Attention should be paid to the significance of the side effects of drugs in the elderly,which may be atypical in the elderly.The relevant side effects of drugs may not be as rare as reported due to individual differences and different pharmacokinetics.If the side effects are generated,the medication should be adjusted in time,and the progress of the side effects should be intervened.展开更多
The influence of amiodarone on intracellular transport of calcium ion in cardiomyocytes of rat was investigated. The experiments were performed on isolated papillary muscles of Wistar rats. Force-frequency dependence ...The influence of amiodarone on intracellular transport of calcium ion in cardiomyocytes of rat was investigated. The experiments were performed on isolated papillary muscles of Wistar rats. Force-frequency dependence (0.7, 1, 2, 3, 4 Hz), extrasystolic and postextrasystolic contractions and post-rest (4-60 s) reactions of rat myocardium after amiodarone treatment (1 μM) were investigated. Decay potentiation coefficient of contraction force was estimated. Results. The analyses of force-frequency dependence has shown that amiodarone prevent the decreasing of the force contraction at increasing of the stimulation frequency. Amiodarone promotes increase of the time constant t1(T50), that indicate the drug promotes acceleration of Са2+ transport inside the SR resulting increase of Са2+ in the places of its release from the sarcoplasmic reticulum (SR). Treatment of papillary muscle with amiodarone decreased amplitude of extrasystolic contractions. As known, postextrasystolic and post-rest reactions of myocardium characterize the SR function. We have found amiodarone increased potentiation of postextrasystolic and post-rest contractions. Preliminary caffeine perfusion of muscles preparations cancelled the amiodarone-induced increasing postextrasystolic and post-rest potentiation. However, potentiation decay coefficient before and after treatment with amiodarone didn’t have difference. Conclusions, amiodarone influences on intracellular calcium ions homeostasis by modulation SR functions related with most likely are stipulated either by activation of Са2+ transport from uptake sites to release sites or by prevent of Са2+ leakage from the SR.展开更多
Objective To evaluate the efficacy and safety of Ding Xin Recipe(DXR)combined with amiodarone in patients with PVCs.Methods A total of360patients with PVCs across7centers in China were randomly assigned in a1:1:1ratio...Objective To evaluate the efficacy and safety of Ding Xin Recipe(DXR)combined with amiodarone in patients with PVCs.Methods A total of360patients with PVCs across7centers in China were randomly assigned in a1:1:1ratio to receive up to8weeks of amiodarone combined with DXR placebo(amiodarone group),DXR combined with amiodarone placebo(DXR group),or DXR combined with amiodarone(DCA group)from July2012to December2013.Randomization was conducted according to a centralized randomization schedule prepared by an independent steering committee.Staff and patients at all sites were masked to treatment allocation.All patients received best-evidence advice.The primary outcome was the efficacy for treating PVCs,with efficacy assessed by the reduction of premature ventricular contractions.Other outcome measures included PVCs-related symptom scores.All data were analyzed by intention to treat.Results The efficacy for treating PVCs in the DCA group(90.7%)significantly increased compared with that in the amiodarone group(72.3%)and the DXR group(73.9%).The frequency,the degree,and the duration per week of heart palpitations,chest tightness,shortness of breath and fatigue improved significantly in the DCA group in comparison with the amiodarone group and the DXR group(P<0.05),while no significant difference was observed in the improvement of insomnia among the three groups(P>0.05).With regard to laboratory parameters for safety,there were no clinically relevant changes in the three groups.Conclusion The present study demonstrates that DXR combined with amiodarone is significantly more effective than DXR or amiodarone alone for treating PVCs.展开更多
Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration a...Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.展开更多
Background Two different interventions are to be tested on patients who have phlebitis caused by Amiodarone therapy. The aim is to prevent or reduce the incidence of phlebitis and observe the effects of both methods. ...Background Two different interventions are to be tested on patients who have phlebitis caused by Amiodarone therapy. The aim is to prevent or reduce the incidence of phlebitis and observe the effects of both methods. Methods A total of 101 patients are divided into observation and control groups ： 51 in the observation group and 50 in the control group. In the observation group, fresh slices of potato were applied on the affected areas of the patients＇ skin, and partially covered with plastic wrap to hold it in place. In the control group, Hirudoid creams were applied on the affected areas of the patients＇ skin. The treatments are administered thrice a day, with each treatment taking 20 minutes. The patients are then observed for incidence of phlebitis at the 24 hour, 48 hour and 72 hour interval. Results Comparing the results of each group across the time intervals, we find that the former is more effective than the latter, and the difference is statistically significant（P 〈 0.05）. Conclusions Applying fresh potato slices is more effective than using Hirudoid cream for treating Amiodarone-induced phlebitis. It is easy to be administered, affordable, and should be considered for wider clinical application.展开更多
Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients...Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.展开更多
文摘Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department of Cardiology of our hospital between August 2022 and August 2023 were selected as research subjects.They were divided into two groups using the coin-tossing method:the combination group(n=35)and the reference group(n=35).The combination group was treated with low-dose Betaloc and amiodarone,and the control group was treated with low-dose Betaloc alone.The treatment efficacy,cardiac function indicators,and related tested indicators of the two groups were compared.Results:The total efficacy of the treatment received by the combination group was much higher than that of the control group(P<0.05).Besides,after treatment,the cardiac function indicators such as left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and cardiac index(CI)of the patients in the combination group were significantly better than those of the reference group(P<0.05).Furthermore,the high-sensitivity C-reactive protein(Hs-CRP),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),adiponectin(APN),and other related test indicators of the patients in the combination group were significantly better than those of the reference group(P<0.05).Conclusion:Low-dose Betaloc combined with amiodarone has a noticeable effect in treating ventricular arrhythmia and deserves to be widely promoted.
基金The Research Special Fund for Public WelfareIndustry of Health(Grant No.200902008)
文摘Warfarin has been used as anticoagulant for the long-term treatment of thromboembolic disease, however, the wide spread use is limited by a wide inter-individual variation in dose requirement. Recent studies have demonstrated that amiodarone may interact with warfarin to potentiate the anticoagulant effects and lead to an elevated international normalized ratio（INR）. In addition, genetic variation in the vitamin K epoxide reductase complex subunit 1（VKORC1） and cytochrome P450 2C9（CYP2C9） may also affect the dose of warfarin in single or combination therapy. In our study, we aim to examine the effect of amiodarone on the warfarin in different CYP2C9 and VKORC1 status. From September 2008 to November 2009, 207 patients from Beijing, China were enrolled in our study, including 34 patients on combination therapy of amiodarone and warfarin and 173 patients on warfarin therapy. VKORCl and CYP2C9 genotypes were examined using ligation detection reaction（LDR） method. We compared the stable dosage of warfarin and INR between patients on warfarin therapy and patients on warfarin-amiodarone therapy when they are stratified with VKORC1 or CYP2C9 genotype. We did not observe significant difference in dosage or INR between these two groups. The difference in characteristics between these two groups, the blood collection time after amiodarone administration and the method for monitoring may all contribute to the negative finding. Large studies taking into account of these factors are needed to improve our understanding of the interaction between warfarin and amiodarone, as well as the effect of genotype in such interaction.
基金supported in part by Sapienza University grant#C26A15M78W(to IL)
文摘Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug reactions—because of changes in pharmacodynamics,concurrent use of multiple medications and the related drug interactions.However,adverse drug reactions are significantly underestimated in the elderly population that is also exposed to inappropriate drugs.Amiodarone is an antiarrhythmic drug used commonly for the treatment of atrial fibrillation and is increasingly prescribed in older people.While amiodarone is an efficient drug for rhythm control,it’s a carrier of different adverse reactions,and pro and cons must be carefully evaluated before its use especially in older people.
基金the Vice Chancellor of Research,Qazvin University of Medical Sciences for financial support
文摘BACKGROUND：Amiodarone is a useful antiarrhythmic drug.Phlebitis,caused by intravenous amiodarone,is common in patients in coronary care units（CCUs）.OBJECTIVE：The aim of this study was to evaluate the effect of topical chamomile on the incidence of phlebitis due to the administration of an amiodarone infusion into the peripheral vein.DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS：This was a randomized,double-blind clinical trial,conducted on 40 patients（n=20 per group）in two groups—an intervention group（chamomile ointment）and a control group（lanoline,as a placebo）,hospitalized in the CCUs and undergoing an amiodarone infusion into the peripheral vein over 24 h.Following the cannulation and commencement of the infusion,placebo or chamomile ointment was rubbed in,up to 10 cm superior to the catheter and repeated every eight hours for three days.The cannula site was then assessed based on the phlebitis checklist.MAIN OUTCOME MEASURES：The incidence and time of occurrence of phlebitis,relative risk,severity of phlebitis were the main outcome measures.RESULTS：Nineteen patients（19/20）in the control group had phlebitis on the first day of the study and one patient（20/20）on the second day.In the intervention group,phlebitis occurred in 13 cases（13/20）on the first day and another two（2/7）was found on the second day.The incidence of phlebitis was significantly different between two groups（P=0.023）.The cumulative incidence of phlebitis in the intervention group（15/20）is significantly later and lower than that in the control group（20/20）during two days（P=0.008）.Two patients in the intervention group did not develop phlebitis at all during the 3-day study.Also,the relative risk of phlebitis in the two groups was 0.68（P=0.008 5）.A significant difference was not observed with regard to phlebitis severity in both groups.CONCLUSION：It seems that phlebitis occurred to a lesser extent and at a later time frame in the intervention group compared to control group.Topical chamomile may be effective in decreasing the incidence of phlebitis due to an amiodarone infusion.
文摘Summary： To study the effect of of lidocaine and amiodarone on the transmural heterogeneity of ventricular repolarization in isolated rabbit hearts model of sustained global ischemia and to explore the mechanisms underlying the antiarrhythmic activity of lidocaine and amiodarone, rabbits were randomly divided into 4 groups： control group, ischemia group, lidocaine group and amiodarone group. By the monophasic action potential （MAP） recording technique, MAPs of epicardium, midmyocardium and endocardium were simultaneously recorded across the left ventricular free wall in rabbit hearts perfused by low-flow ischemia （2. 5 mL/min） in Langendorff method to study the transmural dispcrsion of repolarization （TDR） and arrhythmic induced by ischemia.Our results showed that TDR of three myocardial layers in ischemia group were significantly lengthened after ischemia. TDR was increased from 17.5±3.9 ms to 31.2±4.6 ms at the time that concided with the onset of sustained ventricle arrhythmic. Amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia, and no significant difference was found at other ischemia time points. 5 cases had ventriclar arrhythmia in ischemia group （62. 5%）, but no case in lidocaine group （P〈0.01） and only 1 case in amiodarone group had ventrilar arrhythmia （P〈 0.01）. No significant difference was found between amiodarone group and lidocaine group. It is concluded that TDR of of three myocardial layers increases significantly at ischemia and it is closely associated with development of ventricular arrhythmia, and amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia and has no effects at other ischemia time points.
文摘We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the pathogenesis of IV amiodaroneDILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality.Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.
基金Supported by Grants-in-Aid No. 16590289,16790211 and 16790212, and "Open Research Center" Project for Private Universities: Matching fund Subsidy (2004-2008), from Ministry of Education, Culture, Sports, Science and Technology, Japan
文摘The anti-arrhythmic agent amiodarone （AD） is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established and this regimen is used for long-term medication. Nevertheless, asymptomatic continuous liver injury by AD may increase the risk of step-wise progression of non-alcoholic fatty liver disease. We present an autopsy case of AD-induced liver cirrhosis in a patient who had been treated with a low dose of AD （200 rag/d） daily for 84 too. The patient was a 85-year-old male with a history of ischemic heart disease. Seven years after initiation of treatment with AD, he was admitted with cardiac congestion. The total dose of AD was 528 g. Mild elevation of serum aminotransferase and hepatomegaly were present. Liver biopsy specimens revealed cirrhosis, and under electron microscopy numerous lysosomes with electron-dense, whorled, lamellar inclusions characteristic of a secondary phospholipidosis were observed. Initially, withdrawal of AD led to a slight improvement of serum aminotransferase levels, but unfortunately his general condition deteriorated and he died from complications of pneumonia and renal failure. Long-term administration of daily low doses of AD carries the risk of progression to irreversible liver injury. Therefore, periodic examination of liver function and/or liver biopsy is required for the management of patients receiving long-term treatment with AD.
文摘Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in less than 1% to 3% of patients taking amiodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity. A 29 year old woman with normal liver function was given amiodarone intravenously to treat her atrial fibrillation. She developed acute toxic hepatitis after 24 h. The intravenous form of amiodarone was immediately avoided and replaced by the oral form, using conventional loading doses as soon as the deranged liver function tests had normalized, without recurrence of the hepatitis. These observations show that the occurrence of acute hepatic impairment with intravenous amiodarone does not necessarily preclude the use of this drug by mouth and the necessity of monitoring the hepatic function of patients treated with amiodarone.
文摘Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.
基金Supported by CQAP,Faculty of Science,Menoufia University,Grant#CP4-062-MEN
文摘Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats.Methods:Animals were divided into four groups.Group I was considered as control.Group II was given grapefruit juice at a dose level of 27 mL/kg body weight.Group III was orally administered amiodarone(18 mg/kg body weight)daily for 5 weeks.Animals were sacrificed after 5 weeks of treatment.Bone marrow was collected from the femurs for analysis of chromosomal aberrations and mitotic indices.Testes were removed and stained with H&E for histological examination.Sperms were collected from epidedymis for detection of sperm head abnormalities.Comet assay was used to detect DNA damage.Results:Amiodarone treatment caused a significant increase in the percentage of chromosomal aberrations,decreased the mitotic index and increased DNA damage.The testis showed many histopathological alterations,inhibition of spermatogenesis and morphometric changes.The number of sperm head abnormalities was increased.Treating animals with amiodarone and grapefruit juice caused a reduction in chromosomal aberrations,mitotic index,DNA damage and testicular alterations caused by amiodarone.Conclusions:The results of this study indicated that grapefruit juice ameliorates the cytotoxicty and testicular alterations induced by amiodarone in albino rats and this is may be due to the potent antioxidant effects of its components.
文摘Amiodarone, a class Ⅲ antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodarone-induced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.
基金Science and Technology Bureau of Jiaxing,Zhejiang Province of China,No.2017BY18018。
文摘BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-induced hepatotoxicity in patients on long-term oral amiodarone therapy who underwent dual-energy computed tomography(DECT).CASE SUMMARY We report the clinical and iodine density in the liver using DECT in three patients with amiodarone-induced hepatotoxicity.Liver enzymes were increased in these three patients,and abdominal DECT without contrast medium showed highly increased attenuation in the liver.Furthermore,the iodine concentration in the liver was increased.The first patient with amiodarone-induced reversible hepatotoxicity,showed a reversible course of liver function and a decrease in CT values after discontinuation of amiodarone.The second patient on long-term oral amiodarone had increased iodine concentration in the liver and liver damage,the patient eventually developed rapidly progressive pneumonia and died of multiple organ failure.The third patient,showed an increased iodine concentration in the liver and elevated liver enzymes.However,the patient refused radiofrequency ablation for atrial fibrillation and continued oral amiodarone to control atrial fibrillation,and routine liver function tests were required every 3-6 mo in this patient.CONCLUSION DECT is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.
文摘Amiodarone hydrochloride is a potent anti-arrhythmic agent, known as a multiple ion-channel blocker in the heart. Although it has been detected in the rat brain, there are no data related to its central nervous system （CNS） effects. In this study, we evaluated anticonvulsant and hypnotic effects of amiodarone. Convulsions were induced by phentylenetetrazole （PTZ） （100 mg/kg） or caffeine （300 mg/kg） in mice. In both models, amiodarone prolonged both latency period and time to death, and acted as an anticonvulsant drug. It was found to be more effective in the PTZ model than in the caffeine model; none of the animals treated with 150 mg/kg dose amiodarone had died in the PTZ model. For hypnotic effect, sleeping was induced with pentobarbital （35 mg/kg） in rats. Amiodarone dose-dependently increased the sleeping time （677.7%-725.9%）. In the sleeping test, all rats in 200 mg/kg amiodarone group died. In conclusion, anticonvulsant and hypnotic effects of amiodarone have shown the depressant effects on CNS. These effects may be dependent on its pharmacological properties.
文摘BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with a palpable gallbladder was investigated clinically,radiologically endoscopically and via liver biopsy. RESULTS:Liver biopsy showed amiodarone hepatotoxicity Endoscopic biopsy identified an ampullary adenoma However,the endoscopic ultrasound and intra-operative findings suggested a malignancy,which was confirmed postoperatively. CONCLUSIONS:While the classic findings of Courvoisier’s Law are borne out in this case,the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.
文摘BACKGROUND Amiodarone is a Class III antiarrhythmic drug,which has been adopted for the treatment of atrial fibrillation and ventricular arrhythmia.However,the use of amiodarone can cause lower limb muscle tremors,which is recognized as a rare side effect of this medication.CASE SUMMARY An 84-year-old female was administrated with amiodarone for paroxysmal supraventricular tachycardia and frequent ventricular tachycardia.The patient developed a bilateral gastrocnemius tremor in the course of medication,and the strength of the patient’s bilateral knee flexor and extensor reached 4/5 and 3/5,respectively.After the use of amiodarone was stopped,and the patient was given a small dose of levetiracetam,the lower limb tremor symptoms were significantly mitigated,along with activity and function.CONCLUSION Attention should be paid to the significance of the side effects of drugs in the elderly,which may be atypical in the elderly.The relevant side effects of drugs may not be as rare as reported due to individual differences and different pharmacokinetics.If the side effects are generated,the medication should be adjusted in time,and the progress of the side effects should be intervened.
文摘The influence of amiodarone on intracellular transport of calcium ion in cardiomyocytes of rat was investigated. The experiments were performed on isolated papillary muscles of Wistar rats. Force-frequency dependence (0.7, 1, 2, 3, 4 Hz), extrasystolic and postextrasystolic contractions and post-rest (4-60 s) reactions of rat myocardium after amiodarone treatment (1 μM) were investigated. Decay potentiation coefficient of contraction force was estimated. Results. The analyses of force-frequency dependence has shown that amiodarone prevent the decreasing of the force contraction at increasing of the stimulation frequency. Amiodarone promotes increase of the time constant t1(T50), that indicate the drug promotes acceleration of Са2+ transport inside the SR resulting increase of Са2+ in the places of its release from the sarcoplasmic reticulum (SR). Treatment of papillary muscle with amiodarone decreased amplitude of extrasystolic contractions. As known, postextrasystolic and post-rest reactions of myocardium characterize the SR function. We have found amiodarone increased potentiation of postextrasystolic and post-rest contractions. Preliminary caffeine perfusion of muscles preparations cancelled the amiodarone-induced increasing postextrasystolic and post-rest potentiation. However, potentiation decay coefficient before and after treatment with amiodarone didn’t have difference. Conclusions, amiodarone influences on intracellular calcium ions homeostasis by modulation SR functions related with most likely are stipulated either by activation of Са2+ transport from uptake sites to release sites or by prevent of Са2+ leakage from the SR.
基金funding support from the National Natural Sciences Foundation of China (No. 81373574 and No. 81774213)the Guangdong 211 key Disciplines
文摘Objective To evaluate the efficacy and safety of Ding Xin Recipe(DXR)combined with amiodarone in patients with PVCs.Methods A total of360patients with PVCs across7centers in China were randomly assigned in a1:1:1ratio to receive up to8weeks of amiodarone combined with DXR placebo(amiodarone group),DXR combined with amiodarone placebo(DXR group),or DXR combined with amiodarone(DCA group)from July2012to December2013.Randomization was conducted according to a centralized randomization schedule prepared by an independent steering committee.Staff and patients at all sites were masked to treatment allocation.All patients received best-evidence advice.The primary outcome was the efficacy for treating PVCs,with efficacy assessed by the reduction of premature ventricular contractions.Other outcome measures included PVCs-related symptom scores.All data were analyzed by intention to treat.Results The efficacy for treating PVCs in the DCA group(90.7%)significantly increased compared with that in the amiodarone group(72.3%)and the DXR group(73.9%).The frequency,the degree,and the duration per week of heart palpitations,chest tightness,shortness of breath and fatigue improved significantly in the DCA group in comparison with the amiodarone group and the DXR group(P<0.05),while no significant difference was observed in the improvement of insomnia among the three groups(P>0.05).With regard to laboratory parameters for safety,there were no clinically relevant changes in the three groups.Conclusion The present study demonstrates that DXR combined with amiodarone is significantly more effective than DXR or amiodarone alone for treating PVCs.
文摘Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.
文摘Background Two different interventions are to be tested on patients who have phlebitis caused by Amiodarone therapy. The aim is to prevent or reduce the incidence of phlebitis and observe the effects of both methods. Methods A total of 101 patients are divided into observation and control groups ： 51 in the observation group and 50 in the control group. In the observation group, fresh slices of potato were applied on the affected areas of the patients＇ skin, and partially covered with plastic wrap to hold it in place. In the control group, Hirudoid creams were applied on the affected areas of the patients＇ skin. The treatments are administered thrice a day, with each treatment taking 20 minutes. The patients are then observed for incidence of phlebitis at the 24 hour, 48 hour and 72 hour interval. Results Comparing the results of each group across the time intervals, we find that the former is more effective than the latter, and the difference is statistically significant（P 〈 0.05）. Conclusions Applying fresh potato slices is more effective than using Hirudoid cream for treating Amiodarone-induced phlebitis. It is easy to be administered, affordable, and should be considered for wider clinical application.
基金supported by National Key Technology Research and Development Program(No.2011BAI11B22)Medical Scientific Research Foundation of Guangdong Province(No.B2012002)Guangdong Population and Family Planning Foundation(No.2012264)
文摘Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.
