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Drug management
Published in Gregory YH Lip, Atrial Fibrillation in Practice, 2020
Amiodarone is one of the most widely used antiarrhythmic drugs, especially in patients with underlying ischaemic and/or structural heart disease. Amiodarone, administered both intravenously and orally, appears to be safe and effective for cardioversion of persistent AF. The recent Canadian Trial of Atrial Fibrillation (CTAF) study compared amiodarone with sotalol and propafenone in 403 patients; after 16 months, 63% of patients taking sotalol or propafenone had a recurrence of AF, compared with 35% of those taking amiodarone.
Cardiovascular Drugs
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: The use of Amiodarone should be avoided in pregnant women because the pregnancy experience in humans has shown the risk of congenital goiter/hyperthyroidism and hypothyroidism after in-utero exposure.
Basic pharmacology of cardiac drugs
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Cardiovascular side effects can include hypotension (usually a problem only with intravenous use), bradycardia (which may be aggravated by concomitant therapy with beta-blocking drugs or verapamil), and QT interval prolongation (normally therapeutic, but occasionally excessive and rarely associated with ventricular tachycardias). Non-cardiac effects include photosensitivity, disturbances of sleep, resting tremor, thyrotoxicosis and hypothyroidism, and pulmonary alveolitis (sometimes fatal). The interaction between amiodarone and the thyroid is complex and has been well described. While thyroid function should be assessed before the start of amiodarone therapy, overt thyroid disease develops in less than 2% of patients. One of the best known, but least important, side effects of amiodarone therapy is the development of corneal microdeposits, which can be seen in 98% of patients receiving long-term treatment. These deposits rarely produce symptoms; blurred and halo vision occurs in 1%–2% of cases and diminishes after reduction of the dose. Amiodarone may interact with other drugs. Its additive effects with beta-blocking agents and verapamil, and its ability to elevate serum digoxin levels have already been noted. In addition, potentiation of the effects of warfarin may occur, which usually necessitates reduction of the warfarin dose by about half.
Mexiletine for ventricular arrhythmias in patients with chronic coronary syndrome: a cohort study
Published in Acta Cardiologica, 2022
Giacomo Mugnai, Carla Paolini, Stefano Cavedon, Alessandro Mecenero, Cosimo Perrone, Claudio Bilato
Amiodarone therapy was previously attempted in 28 out of the 34 patients (82.3%). In 6 patients long-term medical therapy with amiodarone was excluded because of the young age (2 cases, 58 and 60 years old, respectively), history of severe dysthyroidism (2 cases) or significant QT prolongation (2 cases). During the observation period before mexiletine initiation, 16 patients (57.1%) experienced important amiodarone toxicity, requiring interruption: iatrogenic hyperthyroidism was observed in 7 cases (43.7%), pulmonary fibrosis in 6 (37.5%), severe hypothyroidism in 2 individuals (12.5%), keratopathy in one case (6.2%). In 8 patients (28.6%) amiodarone was suspended due to complete inefficacy. Four patients (11.8%) still continued amiodarone at the dose of 200 mg per day when mexiltine was initiated.
Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Snigdha Bendaram, Sherif Elkattawy, Muhammad Atif Masood Noori, Hardik Fichadiya, Sarah Ayad, Parminder Kaur, Raja Pullatt, Fayez Shamoon
Amiodarone is effective but has significant side effects; thus, it can be employed in patients where other therapies failed or are not feasible. As per 2014 AHA guidelines, for patients with pre-excitation and rapid ventricular rate, management involves intravenous procainamide in hemodynamically stable patients and synchronized cardioversion in unstable ones. In a small, non-randomized trial containing a subset of patients with AVRT, ten patients treated with a combination of propafenone and beta-blocker therapy had no recurrence at >9 months after discharge [9]. Cardioversion can be performed during any week of pregnancy; although there is a theoretical risk of triggering an arrhythmia in the fetus, the risk is supposed to be small due to the small amount of energy directly reaching the fetus itself [10,11]. However, there have been cases reported of fetal arrhythmias requiring emergent C-section after cardioversion, and hence monitoring fetal heart rhythm is recommended [12].
Cardiac arrhythmias in pregnant women: need for mother and offspring protection
Published in Current Medical Research and Opinion, 2020
Theodora A. Manolis, Antonis A. Manolis, Evdoxia J. Apostolopoulos, Despoina Papatheou, Helen Melita, Antonis S. Manolis
Amiodarone, classified as an FDA class D drug, should be used very cautiously, if at all, during pregnancy due to increased risks for the embryo; due to its high content of iodine, amiodarone may cause neonatal hypothyroidism, small size for gestational age and prematurity (see discussion below)49. Nevertheless, IV amiodarone, administered in the acute setting, may slow ventricular response, or may restore normal sinus rhythm, and can be considered if other measures fail24. However, chronic use of amiodarone for rhythm control is not recommended because of the known side effects to the mother and a potential for serious adverse effects to the fetus. Therefore, it is suggested that amiodarone should only be used in urgent and refractory situations in pregnant women. However, in certain cases, the potential benefits of the drug may outweigh the potential risk.