Electrophysiologic effects of desethylamiodarone, an active metabolite of amiodarone: Comparison with amiodarone during chronic administration in rabbits

Abstract

During acute superfusion studies by means of the standard microelectrode technique, we previously showed that both amiodarone and its major metabolite, desethylamiodarone, had a modest effect on the lengthening of the action potential duration (APD) at high drug concentrations and produced a rate-dependent block of the sodium channel in cardiac muscle. In this study the comparative electrophysiologic effects of the two compounds in rabbits treated chronically with these compounds were determined with particular reference to repolarization and sinus node automaticity. The changes were correlated with those in serum and tissue drug levels and in thyroid hormone indices. After 1 week neither compound had a significant effect on atrial or sinus nodal potentials; after 3 weeks, amiodarone increased the atrial APD at 90% repolarization time by 10.5% ( p < 0.05) and the effective refractory period (ERP) by 6.7% ( p < 0.05). The corresponding figures for desethylamiodarone were 13% (NS) and 18% (NS). The sinus cycle length was increased 12% (NS) by amiodarone and 27.9% ( p < 0.05) after the metabolite. In animals treated for 6 weeks, amiodarone increased the ventricular APD at 90% repolarization by 58.8% ( p < 0.001) and desethylamiodarone by 42.0% the corresponding figures for the ERP were 63.4% ( p < 0.01) and 47.4% ( p < 0.01), respectively. At the stimulation frequency used, neither compound exerted a significant effect on V max. Both amiodarone and desethylamiodarone significantly decreased serum triiodothyronine and increased reverse triiodothyronine levels but had no effect on thyroxine. Neither the electrophysiologic effects nor those in thyroid hormone indices could be related systematically to the serum or tissue levels of amiodarone or desethylamiodarone. The data indicate the after chronic drug administration, desethylamiodarone exerts electrophysiologic effects, the magnitude and latency of onset of which were comparable to those of the parent compound. The metabolite has significant electrophysiologic effects that are likely to be additive to those of the parent compound during chronic administration.