Maintenance Dose Of Amiodarone Research Articles

Efficacy of amiodarone in the treatment of ventricular arrhythmias in patients with coronary artery disease in Bangladesh

Background: Ventricular arrhythmias (VA) are among the most feared complications of coronary artery disease (CAD) and one of the major contributors of death in CAD patients. Antiarrhythmic drug (AAD) therapy is required for recurrent significant VA in the absence of need for further revascularization. But all AADs do not have the same efficacy against life threatening VA and supraventricular arrhythmias (SVAs).
 Methodology: All (50) patients admitted in the department of Cardiology, BSMMU with ventricular arrhythmias with CAD fulfilling the inclusion and exclusion criteria were included in the study. Informed written consent was taken from each patient before enrollment. Detailed history was taken and relevant physical examinations were done. Loading dose followed by maintenance dose of amiodarone was given and recorded. Relevant lab investigations were performed and recorded in predesigned semi-structured data collection sheet. Symptomatic improvement was assessed, relevant physical examination was done and lab investigations were performed at 1, 3 and 6 month follow up. After editing data analysis was carried out by using the Statistical Package for Social Science (SPSS) version 23.0 windows software.
 Results: The mean age was found 57.7±8.0 years with a range of 45 to 78 years. Almost two third (62.0%) patients were male and 19(38.0%) patients were female. Male female ratio was 1.6:1. Almost three fourth (74.0%) patients had chest pain, 15(30.0%) had palpitation and 11(22.0%) had shortness of breath. Two third (66.0%) patients had hypertension, 23(46.0%) had dyslipidemia, 17(34.0%) had smoking and 9(18.0%) had diabetes mellitus. Twenty nine (58.0%) patients had family history of IHD. The difference was statistically significant (p<0.05) when compared to baseline. Regarding arrhythmia, 45(90.0%) patients was found to have PVC in baseline and 3(6.4%) at 6th month. The reduction of PVC and VT at six month were statistically significant (p<0.05) when compared to baseline. Regarding outcome 2(4.1%) patients died, one patient dropped out due to thyroid dysfunction and 47 were alive.
 Conclusion: In conclusion it was found that different forms of ventricular arrhythmias like PVCs, VT were significantly reduced gradually with amiodarone therapy at 6th month follow up.
 J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 158-164

Electrical cardioversion in a dog with atrial fibrillation and hypothyroidism

A three‐year‐old male neutered Bullmastiff cross was assessed for lethargy. The dog had recently been diagnosed with atrial fibrillation and hypothyroidism and had been started on thyroid supplementation and cardiac medications. ECG on presentation confirmed atrial fibrillation. Echocardiography showed normal chamber dimensions, making heart failure unlikely. With the lack of structural heart disease, a diagnosis of lone atrial fibrillation was made. After initial medical management of the atrial fibrillation with rate control, the client elected electrical cardioversion. The dog was pretreated with amiodarone and transthoracic electrical cardioversion was performed. Atrial fibrillation was successfully converted to normal sinus rhythm, and the dog was discharged on a maintenance dose of amiodarone. The dog remained in a normal sinus rhythm at the 1‐, 2‐, 4‐, 8‐ and 14‐month revisits. This case report describes management options for atrial fibrillation and the potential association with hypothyroidism.

Miocardiopatía arritmogénica del ventrículo derecho. Breve revisión de la literatura a propósito de un caso

A 51-year-old man was admitted to this hospital because of palpitations and a feeling of dizziness for a period of 2h. The electrocardiogram revealed a regular wide-QRS complex tachycardia at a rate of 250 beats per minute, with superior axis and left bundle branch block morphology without hemodynamically decompensation, the patient was cardioverted to sinus rhythm after the administration of a loading and maintenance dose of amiodarone. The elechtrophysiological study showed the ventricular origin of the arrhythmia. In order to diagnose the etiology of the ventricular tachycardia we performed a coronary arteriography that showed normal epicardial vessels, thus ruling out coronary disease. Doppler echocardiography revealed systolic and diastolic functions of both left and right ventricles within normal parameters, and normal diameters as well. A cardiac magnetic resonance with late enhancement was done, showing structural abnormalities of the right ventricle wall with moderate impairment of the ejection fraction, and a mild dysfunction of the left ventricle. The diagnosis of arrhythmogenic right ventricular cardiomyopathy was performed as 2 major Task Force criteria were met. We implanted an automatic cardioverter defibrillator as a prophylactic measure. The patient was discharged without complications.

LONG-TERM EFFICACY OF THE LOW DOSE AMIODARONE THERAPY FOR THE PREVENTION OF RECURRENCE OF PAROXYSMAL ATRIAL FIBRILLATION

ObjectivesTo investigate the efficacy and safety of the low dose oral amiodarone therapy in patients for the long-term prevention of paroxysmal atrial fibrillation (PAF).Methods Usage of AmiodaroneAfter conversion by using...

Clinical Observations With the Amiodarone/Warfarin Interaction: Dosing Relationships With Long-term Therapy

The interaction between amiodarone and warfarin has only been described in patients being followed up for relatively short time periods. The objectives of this study were to characterize the interaction between these two agents in a clinical situation over a longer period of time in a larger cohort of patients, and to determine the relationship between the maintenance dose of amiodarone and the resultant need to adjust the dose of warfarin. This was an observational trial of a cohort of patients receiving a stable warfarin regimen in whom oral amiodarone was initiated. Patients received both amiodarone and warfarin for at least 1 year, and the dosage of warfarin was adjusted as clinically necessary to achieve an international normalized ratio of 2 to 3. Data from a total of 43 patients were analyzed. At baseline, prior to initiation of amiodarone, the warfarin dose was 5.2 +/- 2.6 mg/d. The magnitude of the interaction between these two agents peaked at 7 weeks, which resulted in a 44% mean maximum reduction in the warfarin dose. The warfarin dose inversely correlated with the maintenance dose of amiodarone (r(2) = 0.94, p < 0.005). Minor bleeding episodes occurred in five patients (12%). For patients receiving amiodarone maintenance doses of 400, 300, 200, or 100 mg/d, it is recommended that the daily warfarin dose be reduced by approximately 40%, 35%, 30%, or 25%, respectively. The magnitude of the amiodarone/warfarin interaction is highly dependent on the maintenance dose of amiodarone. This relationship can aid clinicians in adjusting the dose of warfarin patients receiving long-term amiodarone treatment.

A Case of Amiodarone-Induced Pulmonary Toxicity After a Long Course of a Low Dose Therapy

Amidarone is one of the most commonly prescribed anti-arrythmic agents for almost all arrythmias, whether atrial or ventricular in origin. There are several side effects associated with amiodarone therapy. These include corneal deposits, abnormal liver function tests, hyper and hypothyroidism, bluish discolorations of the skin, bone marrow suppression, coagulopathies, peripheral neuropathies, and pulmonary toxicity. Amiodarone-induced pulmonary toxicity(APT), which was first described in 1980, is potentially serious side effects that are believed to develop in 5% of patients. Doctors often assume that APT occurs only when high amiodarone doses are used for a long time, but in practice a low maintenance dose of amiodarone may also be toxic. In this report, a case of amiodarone-induced pulmonary toxicity after a long course of a low dose therapy for refractory supraventricular arrythmia is described.

The effectiveness and safety of the simultaneous administration of quinidine and amiodarone in the conversion of chronic atrial fibrillation

The effectiveness and safety of quinidine in the conversion of chronic atrial fibrillation after administration of amiodarone was assessed in 15 patients. A total quinidine dosage of 1097 ± 408 mg was administered up the point of conversion or for a total of 48 hours. Nine of 15 patients (60%) converted to sinus rhythm. No clinical variable such as the duration of atrial fibrillation, left atrial size, left ventricular fractional shortening, amiodarone duration, or maintenance dose of amiodarone was able to discriminate between converters and nonconverters when patients were treated with the combination of amiodarone and quinidine. The mean QT interval with amiodarone was 414 ± 44 msec and slightly increased to 434 ± 40 msec ( p = 0.01) when quinidine was added. The amiodarone-quinidine combination was well tolerated, and no side effects or proarrhythmias were recorded.