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Deng JH, Jia B, Yao YT. The efficacy and safety of intraoperative intravenous amiodarone in patients undergoing on-pump coronary artery bypass grafting surgery: a systemic review and PRISMA-compliant meta-analysis. J Cardiothorac Surg 2024; 19:274. [PMID: 38702789 PMCID: PMC11067272 DOI: 10.1186/s13019-024-02732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND To evaluate the clinical efficacy and safety of intraoperative intravenous amiodarone for arrhythmia prevention in on-pump coronary artery bypass grafting (CABG) patients. METHODS A meta-analysis of randomized controlled trials was conducted. Pubmed, Embase, Cochrane Library, Ovid, China National Knowledge Infrastructure, and the Wan Fang database until July 1th, 2023. The primary outcomes of interest included the incidences of intra- and post-operative atrial fibrillation (POAF), ventricular fibrillation, or any arrhythmia, including atrial fibrillation, ventricular fibrillation, ventricular tachycardia, premature ventricular contraction, and sinus bradycardia. For continuous and dichotomous variables, treatment effects were calculated as the weighted mean difference (WMD)/risk ratio (RR) and 95% confidence interval (CI). RESULTS A database search yielded 7 randomized controlled trials including 608 patients, where three studies, including three treatments (amiodarone, lidocaine, and saline), contributed to the clinical outcome of atrial fibrillation, ventricular fibrillation, or any arrhythmia. Meta-analysis demonstrated that amiodarone can significantly reduce the incidence of POAF (RR, 0.39; 95%CI: 0.20, 0.77; P = 0.007, I2 = 0%) in patients undergoing on-pump CABG; there was no statistically significant influence on intra-operative atrial fibrillation, intra- and post-operative ventricular fibrillation, or any arrhythmia. CONCLUSIONS The current study suggests that intraoperative administration of intravenous amiodarone may be safe and effective in preventing POAF in patients undergoing on-pump CABG. More well-designed clinical trials are needed to validate this result.
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Affiliation(s)
- Jin-He Deng
- Department of Anesthesiology, Guangdong Provincial Hospital of Chinese Medicine, (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Province, Guangzhou, 510000, China
| | - Bin Jia
- Department of Anesthesiology, Guangdong Provincial Hospital of Chinese Medicine, (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Province, Guangzhou, 510000, China
| | - Yun-Tai Yao
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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Trohman RG, Sharma PS, McAninch EA, Bianco AC. Amiodarone and thyroid physiology, pathophysiology, diagnosis and management. Trends Cardiovasc Med 2019; 29:285-295. [PMID: 30309693 PMCID: PMC6661016 DOI: 10.1016/j.tcm.2018.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/15/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022]
Abstract
Although amiodarone is considered the most effective antiarrhythmic agent, its use is limited by a wide variety of potential toxicities. The purpose of this review is to provide a comprehensive "bench to bedside" overview of the ways amiodarone influences thyroid function. We performed a systematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2017. Amiodarone was searched using the terms adverse effects, hypothyroidism, myxedema, hyperthyroidism, thyroid storm, atrial fibrillation, ventricular arrhythmia, and electrical storm. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. We included 163 germane references in this review. Because amiodarone is one of the most frequently prescribed antiarrhythmic drugs in the United States, the mechanistic, diagnostic and therapeutic information provided is relevant for practicing clinicians in a wide range of medical specialties.
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Affiliation(s)
- Richard G Trohman
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States.
| | - Parikshit S Sharma
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth A McAninch
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Antonio C Bianco
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
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Denault AY, Beaulieu Y, Couture P, Haddad F, Shi Y, Pagé P, Levesque S, Tardif JC, Lambert J. Acute intraoperative effect of intravenous amiodarone on right ventricular function in patients undergoing valvular surgery. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:316-25. [PMID: 25178692 DOI: 10.1177/2048872614549102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Amiodarone is commonly used in the acute care setting. However the acute hemodynamic and echocardiographic effect of intravenous amiodarone administered intraoperatively on right ventricular (RV) systolic and diastolic function using transesophageal echocardiography (TEE) has not been described. METHODS The study design was a randomized controlled trial in elective cardiac surgical patients undergoing valvular surgery. Patients received an intravenous loading dose of 300 mg of either amiodarone or placebo in the operating room, followed by an infusion of 15 mg/kg for two days. Hemodynamic profiles, echocardiographic measurement of RV and left ventricular (LV) dimensions, Doppler interrogation of tricuspid and mitral valve, hepatic and pulmonary venous flow combined with tissue Doppler imaging of the tricuspid and mitral valve annulus were obtained before and after bolus. RESULTS Although more patients in the placebo group had chronic obstructive lung disease (14 vs 6, p=0.05) and diabetes (14 vs 5; p=0.0244), there was no difference in terms of baseline hemodynamic, 2D and Doppler variables. After bolus, a significant increase in pulmonary artery pressure, central venous pressure and pulmonary vascular resistance index (p<0.05) was observed in the amiodarone group with reduction in systolic to diastolic (S/D) ratio of the hepatic (p=0.0247) and pulmonary venous (p=0.0052) velocity. CONCLUSION Acute administration of amiodarone is associated with alteration in RV diastolic properties and has minimal negative inotropic effect on RV systolic function in cardiac surgical patients with valvular disease.
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Affiliation(s)
- André Y Denault
- Department of Anesthesiology, and Division of Critical Care, Montreal Heart Institute, Université de Montréal, Canada Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Canada
| | - Yanick Beaulieu
- Department of Medicine and Critical Care Division, Hôpital du Sacré-Coeur, Université de Montréal, Canada
| | - Pierre Couture
- Department of Anesthesiology, and Division of Critical Care, Montreal Heart Institute, Université de Montréal, Canada
| | - Francois Haddad
- Stanford Division of Cardiovascular Medicine, Stanford University School of Medicine, USA
| | - Yanfen Shi
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Pierre Pagé
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Canada
| | | | - Jean-Claude Tardif
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Jean Lambert
- Department of Preventive and Social Medicine, Université de Montréal, Canada
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4
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Suzuki T, Morishima M, Kato S, Ueda N, Honjo H, Kamiya K. Atrial selectivity in Na+channel blockade by acute amiodarone. Cardiovasc Res 2013; 98:136-44. [DOI: 10.1093/cvr/cvt007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Grecian R, Ainslie M. Acute hepatic failure following intravenous amiodarone. BMJ Case Rep 2012; 2012:bcr-2012-007080. [PMID: 23257638 DOI: 10.1136/bcr-2012-007080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 73-year-old gentleman presented to the hospital after an episode of loss of consciousness. He had a defibrillator in situ, which on interrogation was found to have fired for an episode of ventricular fibrillation. As an inpatient he developed frequent episodes of self-terminating ventricular tachycardia, treated initially with oral amiodarone. A 24 h amiodarone infusion was started on day 3 of admission, following which the patient developed hyperventilation. Investigations revealed that this was secondary to acute hepatic and renal failure, requiring haemofiltration on the intensive care unit. Cessation of amiodarone was associated with normalisation of liver function over 48 h. The patient had normal blood and jugular venous pressures throughout days 1-4 of admission. We discuss the role of amiodarone as the predominant factor in the deterioration of this patient's liver function, versus the differential diagnosis of ischaemia-induced hepatotoxicity, citing recent research regarding this subject.
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Souney PF, Cooper WD, Cushing DJ. PM101: intravenous amiodarone formulation changes can improve medication safety. Expert Opin Drug Saf 2010; 9:319-33. [PMID: 20074019 DOI: 10.1517/14740331003586811] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paul F Souney
- Prism Pharmaceuticals, Inc., 1016 West Ninth Avenue, Suite 130, King of Prussia, PA 19406, USA ;
| | - Warren D Cooper
- Prism Pharmaceuticals, Inc., 1016 West Ninth Avenue, Suite 130, King of Prussia, PA 19406, USA
| | - Daniel J Cushing
- Prism Pharmaceuticals, Inc., 1016 West Ninth Avenue, Suite 130, King of Prussia, PA 19406, USA
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Abstract
The subspecialty of interventional cardiology began in 1977. Since then, the discipline of interventional cardiology has matured rapidly, particularly with regards to ischemic heart disease. As a result, more patients are undergoing percutaneous catheter interventional therapy for ischemic heart disease and fewer patients are undergoing surgical myocardial revascularization. Those patients referred for surgical revascularization are generally older and have more complex problems. Furthermore, as the population ages more patients are referred to surgery for valvular heart disease. The result of these changes is a population of surgical patients older and sicker than previously treated.
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8
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Prophylactic amiodarone versus lidocaine for prevention of reperfusion ventricular fibrillation after release of aortic cross-clamp. Eur J Anaesthesiol 2009; 26:1056-60. [DOI: 10.1097/eja.0b013e32832f0dfb] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Haas NA, Camphausen CK. Impact of early and standardized treatment with amiodarone on therapeutic success and outcome in pediatric patients with postoperative tachyarrhythmia. J Thorac Cardiovasc Surg 2008; 136:1215-22. [DOI: 10.1016/j.jtcvs.2008.04.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Revised: 02/28/2008] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
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10
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Acute hemodynamic effects of intravenous amiodarone treatment in paediatric cardiac surgical patients. Clin Res Cardiol 2008; 97:801-10. [DOI: 10.1007/s00392-008-0683-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 05/16/2008] [Indexed: 11/24/2022]
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Sleeswijk ME, Van Noord T, Tulleken JE, Ligtenberg JJM, Girbes ARJ, Zijlstra JG. Clinical review: treatment of new-onset atrial fibrillation in medical intensive care patients--a clinical framework. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:233. [PMID: 18036267 PMCID: PMC2246197 DOI: 10.1186/cc6136] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation occurs frequently in medical intensive care unit patients. Most intensivists tend to treat this rhythm disorder because they believe it is detrimental. Whether atrial fibrillation contributes to morbidity and/or mortality and whether atrial fibrillation is an epiphenomenon of severe disease, however, are not clear. As a consequence, it is unknown whether treatment of the arrhythmia affects the outcome. Furthermore, if treatment is deemed necessary, it is not known what the best treatment is. We developed a treatment protocol by searching for the best evidence. Because studies in medical intensive care unit patients are scarce, the evidence comes mainly from extrapolation of data derived from other patient groups. We propose a treatment strategy with magnesium infusion followed by amiodarone in case of failure. Although this strategy seems to be effective in both rhythm control and rate control, the mortality remained high. A randomised controlled trial in medical intensive care unit patients with placebo treatment in the control arm is therefore still defendable.
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12
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Salgado HC, Simões GM, Santana Filho VJ, Dias da Silva VJ, Salgado MCO, Fazan R. Negative inotropic and lusitropic effects of intravenous amiodarone in conscious rats. Clin Exp Pharmacol Physiol 2007; 34:870-5. [PMID: 17645632 DOI: 10.1111/j.1440-1681.2007.04676.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1. The acute effect of amiodarone on haemodynamics (mean arterial pressure and heart rate) and ventricular function (+dP/dt(max) and -dP/dt(max)) was investigated in conscious rats. In addition, the effects of amiodarone on dobutamine stress were determined. 2. Catheters were inserted in rats into the left ventricle and femoral artery and vein. Three groups of rats received 25 or 50 mg/kg, i.v., amiodarone or vehicle (a 1:1:8 mixture of Tween 80:99.5% ethanol:distilled water), followed by dobutamine (10 microg/kg). 3. The hypotensive effect of 50 mg/kg amiodarone was combined with marked bradycardia and attenuation of +dP/dt(max) and -dP/dt(max). A slight, but significant, hypotension was caused by 25 mg/kg amiodarone, without affecting heart rate, +dP/dt(max) and -dP/dt(max). However, although both doses of amiodarone attenuated the tachycardia caused by dobutamine, neither 25 nor 50 mg/kg amiodarone affected the increase in mean arterial pressure or the enhanced response of +dP/dt(max) and -dP/dt(max). 4. In conclusion, amiodarone caused hypotension, bradycardia, negative inotropic (+dP/dt(max)) and lusitropic (-dP/dt(max)) effects in conscious rats. In addition, amiodarone attenuated the tachycardia without affecting the hypertensive, contractile (+dP/dt(max)) and lusitropic (-dP/dt(max)) responses to dobutamine stress.
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Affiliation(s)
- Helio C Salgado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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13
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Howard PA, Barnes BJ. Amiodarone Prophylaxis: Impact on Atrial Fibrillation and Outcomes after Cardiac Surgery. Hosp Pharm 2007. [DOI: 10.1310/hpj4208-680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This continuing feature will update readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number one killer in the United States, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, pharmacists can have a significant impact on prevention and treatment—if they keep current with developments in drug therapy.
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Affiliation(s)
| | - Brian J. Barnes
- Department of Pharmacy Practice, Department of Cardiothoracic Surgery, University of Kansas Medical Center, Kansas City, Kan
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Barnes BJ, Kirkland EA, Howard PA, Grauer DW, Gorton ME, Kramer JB, Muehlebach GF, Reed WA. Risk-Stratified Evaluation of Amiodarone to Prevent Atrial Fibrillation After Cardiac Surgery. Ann Thorac Surg 2006; 82:1332-7. [PMID: 16996929 DOI: 10.1016/j.athoracsur.2006.04.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 04/19/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Amiodarone prophylaxis (AMP) reduces the prevalence of postoperative atrial fibrillation (POAF) after cardiac surgery. We investigated the impact of AMP on the frequency and duration of POAF, the intensive care unit and hospital length of stay, and its cost-effectiveness in a risk-stratified cohort. METHODS A retrospective, observational analysis of 509 patients who underwent cardiac surgery in 2003 was performed. Data sources included The Society of Thoracic Surgeons national database; medical and medication administration records; and the activity-based cost data from our institution. Risk stratification for POAF was determined using a validated risk index. Cost-effectiveness was determined from the hospital's perspective. RESULTS The mean patient age was 63 years, 27% were female, 80% underwent coronary artery bypass grafting, and 29% underwent valve surgery. When a risk-stratified evaluation was made, 50% of patients were at an elevated risk for having POAF develop. When compared with nonprophylaxed patients, those receiving AMP (59%) experienced less POAF (31% vs 22%; p = 0.027) and shorter durations of POAF (4.7 vs 2.7 days; p = 0.025). In the elevated-risk group, AMP clinically (but not significantly) reduced length of stay in the intensive care unit (101 vs 68 hours; p > 0.05) and post-procedural hospital length of stay (9.7 vs. 7.9 days, p > 0.05). In the elevated-risk group, AMP was robustly cost-effective in reducing POAF. CONCLUSIONS Amiodarone prophylaxis reduced the prevalence and duration of POAF. Baseline risk for POAF was a major determinant of the overall cost-effectiveness of AMP. The greatest cost savings with AMP was seen in patients at an elevated risk for POAF. These findings suggest the need for risk stratification when prescribing AMP.
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Affiliation(s)
- Brian J Barnes
- Department of Pharmacy Practice, School of Pharmacy, The University of Kansas Medical Center, Kansas City, Kansas 66160-7231, USA.
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Oliveira PF, Dias da Silva VJ, Salgado MCO, Fazan R, Aguiar CA, Salgado HC. Acute effect of amiodarone on cardiovascular reflexes of normotensive and renal hypertensive rats. Braz J Med Biol Res 2005; 38:967-76. [PMID: 15933792 DOI: 10.1590/s0100-879x2005000600020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to evaluate the effect of amiodarone on mean arterial pressure (MAP), heart rate (HR), baroreflex, Bezold-Jarisch, and peripheral chemoreflex in normotensive and chronic one-kidney, one-clip (1K1C) hypertensive rats (N = 9 to 11 rats in each group). Amiodarone (50 mg/kg, iv) elicited hypotension and bradycardia in normotensive (-10 +/- 1 mmHg, -57 +/- 6 bpm) and hypertensive rats (-37 +/- 7 mmHg, -39 +/- 19 bpm). The baroreflex index (deltaHR/deltaMAP) was significantly attenuated by amiodarone in both normotensive (-0.61 +/- 0.12 vs -1.47 +/- 0.14 bpm/mmHg for reflex bradycardia and -1.15 +/- 0.19 vs -2.63 +/- 0.26 bpm/mmHg for reflex tachycardia) and hypertensive rats (-0.26 +/- 0.05 vs -0.72 +/- 0.16 bpm/mmHg for reflex bradycardia and -0.92 +/- 0.19 vs -1.51 +/- 0.19 bpm/mmHg for reflex tachycardia). The slope of linear regression from delta pulse interval/deltaMAP was attenuated for both reflex bradycardia and tachycardia in normotensive rats (-0.47 +/- 0.13 vs -0.94 +/- 0.19 ms/mmHg and -0.80 +/- 0.13 vs -1.11 +/- 0.13 ms/mmHg), but only for reflex bradycardia in hypertensive rats (-0.15 +/- 0.02 vs -0.23 +/- 0.3 ms/mmHg). In addition, the MAP and HR responses to the Bezold-Jarisch reflex were 20-30% smaller in amiodarone-treated normotensive or hypertensive rats. The bradycardic response to peripheral chemoreflex activation with intravenous potassium cyanide was also attenuated by amiodarone in both normotensive (-30 +/- 6 vs -49 +/- 8 bpm) and hypertensive rats (-34 +/- 13 vs -42 +/- 10 bpm). On the basis of the well-known electrophysiological effects of amiodarone, the sinus node might be the responsible for the attenuation of the cardiovascular reflexes found in the present study.
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Affiliation(s)
- P F Oliveira
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 14049-900 Ribeirão Preto, SP, Brasil
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Lessa MA, Tibiriçá E. Acute cardiodepressant effects induced by bolus intravenous administration of amiodarone in rabbits. Fundam Clin Pharmacol 2005; 19:165-72. [PMID: 15810896 DOI: 10.1111/j.1472-8206.2004.00308.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Amiodarone is a potent anti-arrhythmic with a large pharmacological spectrum that shares the mechanisms of action of all classes of anti-arrhythmic drugs. Originally used in the treatment of supraventricular arrhythmias, it has also been used to treat ventricular tachyarrhythmias. The recent inclusion of amiodarone in the Advanced Cardiac Life Support protocols warrants the characterization of the hemodynamic profile resulting from the rapid venous administration of the drug. Thus, the main purpose of the present study was to investigate the acute hemodynamic profile resulting from the bolus i.v. injection of amiodarone, compared with bolus i.v. administration of lidocaine. We investigated the acute hemodynamic effects of amiodarone and lidocaine, in an experimental model of open-chest pentobarbital-anesthetized rabbits (n = 24). Amiodarone (5 mg/kg) induced immediate reductions in mean arterial pressure (MAP) of 32 +/- 5% (P < 0.001), accompanied by reductions in cardiac contractility and relaxation, as assessed by left ventricular (LV) +dP/dt(max) and -dP/dt(max) (40 +/- 4 and 36 +/- 4% respectively) (P < 0.001), heart rate (HR) 10 +/- 1% (P < 0.05), cardiac output (CO) 24 +/- 5% (P < 0.001) and systemic vascular resistance (SVR) 19 +/- 3.5% (P < 0.05). Lidocaine (3 mg/kg) induced reductions in: MAP of 18 +/- 7% (P < 0.001), LV +dP/dt(max) and -dP/dt(max) (40 +/- 5 and 22 +/- 7% respectively) (P < 0.001), HR 7 +/- 1% (P < 0.01) and CO of 23 +/- 6% (P < 0.001). SVR increased by 9 +/- 1.5% (P > 0.05). It is concluded that rapid i.v. administration of both amiodarone and lidocaine induces significant cardiovascular depression mainly characterized by immediate reductions in cardiac contractility.
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Affiliation(s)
- Marcos Adriano Lessa
- Departamento de Fisiologia e Farmacodinâmica, Instituto Oswaldo Cruz, FIOCRUZ. Av. Brasil 4365, C.P. 926, 21045-900 Rio de Janeiro, Brazil
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Affiliation(s)
- John G Augoustides
- Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA
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