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Francisco-Pascual J, Mallofré Vila N, Santos-Ortega A, Rivas-Gándara N. Tachyarrhythmias in congenital heart disease. Front Cardiovasc Med 2024; 11:1395210. [PMID: 38887448 PMCID: PMC11180807 DOI: 10.3389/fcvm.2024.1395210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
The prevalence of congenital heart disease (CHD) in adult patients has risen with advances in diagnostic and surgical techniques. Surgical modifications and hemodynamic changes increase the susceptibility to arrhythmias, impacting morbidity and mortality rates, with arrhythmias being the leading cause of hospitalizations and sudden deaths. Patients with CHD commonly experience both supraventricular and ventricular arrhythmias, with each CHD type associated with different arrhythmia patterns. Macroreentrant atrial tachycardias, particularly cavotricuspid isthmus-dependent flutter, are frequently reported. Ventricular arrhythmias, including monomorphic ventricular tachycardia, are prevalent, especially in patients with surgical scars. Pharmacological therapy involves antiarrhythmic and anticoagulant drugs, though data are limited with potential adverse effects. Catheter ablation is preferred, demanding meticulous procedural planning due to anatomical complexity and vascular access challenges. Combining imaging techniques with electroanatomic navigation enhances outcomes. However, risk stratification for sudden death remains challenging due to anatomical variability. This article practically reviews the most common tachyarrhythmias, treatment options, and clinical management strategies for these patients.
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Affiliation(s)
- Jaume Francisco-Pascual
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Mallofré Vila
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Santos-Ortega
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Rivas-Gándara
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
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2
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O'Leary E, Valente AM, Tadros T. Tempering the Storm of Arrhythmias in Adults With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e9566. [PMID: 38629434 PMCID: PMC11179894 DOI: 10.1161/jaha.124.034536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Edward O'Leary
- Department of CardiologyBoston Children’s HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Anne Marie Valente
- Department of CardiologyBoston Children’s HospitalBostonMAUSA
- Department of Cardiology MedicineDivision of CardiologyBrigham and Women’s HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Thomas Tadros
- Department of Cardiology MedicineDivision of CardiologyBrigham and Women’s HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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Agha MS, Ermis PR, Franklin WJ, Parekh DR, Opina AD, Kim JJ, Miyake CY, Valdes SO, Lam WW. Dronedarone for the Treatment of Atrial Arrhythmias in Adults With Congenital Heart Disease. Tex Heart Inst J 2024; 51:e227993. [PMID: 38686681 DOI: 10.14503/thij-22-7993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Atrial tachyarrhythmias are common and difficult to treat in adults with congenital heart disease. Dronedarone has proven effective in patients without congenital heart disease, but data are limited about its use in adults with congenital heart disease of moderate to great complexity. METHODS A single-center, retrospective chart review of 21 adults with congenital heart disease of moderate to great complexity who were treated with dronedarone for atrial tachyarrhythmias was performed. RESULTS The median (IQR) age at dronedarone initiation was 35 (27.5-39) years. Eleven patients (52%) were male. Ten patients (48%) had New York Heart Association class I disease, 10 (48%) had class II disease, and 1 (5%) had class III disease. Ejection fraction at initiation was greater than 55% in 11 patients (52%), 35% to 55% in 9 patients (43%), and less than 35% in 1 patient (5%). Prior treatments included β-blockers (71%), sotalol (38%), amiodarone (24%), digoxin (24%), and catheter ablation (38%). Rhythm control was complete in 5 patients (24%), partial in 6 (29%), and inadequate in 10 (48%). Two patients (10%) experienced adverse events, including nausea in 1 (5%) and cardiac arrest in 1 (5%), which occurred 48 months after initiation of treatment. There were no deaths during the follow-up period. The median (IQR) follow-up time for patients with complete or partial rhythm control was 20 (1-54) months. CONCLUSION Dronedarone can be effective for adult patients with congenital heart disease and atrial arrhythmias for whom more established therapies have failed, and with close monitoring it can be safely tolerated.
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Affiliation(s)
- Mahdi S Agha
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter R Ermis
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wayne J Franklin
- Department of Pediatrics, Division of Cardiology, The University of Arizona College of Medicine, Phoenix, Arizona
| | - Dhaval R Parekh
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Angeline D Opina
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christina Y Miyake
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Santiago O Valdes
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wilson W Lam
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
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Kakarla J, Crossland DS, Murray S, Adhvaryu K, Jansen K, Rybicka J, Hermuzi A, Martin R, Shepherd E, Seller N, Coats L. An unmet need: arrhythmia detection by implantable loop recorder in the systemic right ventricle. Europace 2023; 25:euad304. [PMID: 37816150 PMCID: PMC10634521 DOI: 10.1093/europace/euad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
AIMS Patients with systemic right ventricles are at high risk of sudden cardiac death. Arrhythmia is a significant risk factor. Routine Holter monitoring is opportunistic with poor adherence. The aim of this study was to determine if continuous rhythm monitoring with an implantable loop recorder (ILR) could allow early detection of clinically important arrhythmias. METHODS AND RESULTS Implantable loop recorder implantation was offered to patients with atrial switch repair for transposition of the great arteries. Recordings were made with symptoms or, automatically for pauses, significant bradycardia or tachycardia and reviewed by the multi-disciplinary team. Twenty-four out of 36 eligible patients underwent ILR implantation with no complication. Forty-two per cent had preserved ventricular function, 75% were NYHA functional class I, 88% had low sudden cardiac death risk, 33% had previous intra-atrial re-entrant tachycardia (IART), and none had known conduction disease. Eighteen out of 24 (75%) patients made 52 recordings (52% automated) over 39.5 months (1.6-72.5). Thirty-two out of 52 (62%) recordings in 15/24 (63%) of the cohort were clinically significant and included sinus node disease (two patients), atrioventricular block (two patients), IART (seven patients), and IART with sinus node disease or atrioventricular block (four patients). Implantable loop recorder recordings prompted medication change in 11 patients [beta-blockers (n = 9), anti-coagulation (n = 5), and stopping anti-coagulation (n = 1)] and device therapy recommendation in seven patients [five pacemakers (three: atrioventricular block) and two defibrillators]. Two patients declined intervention; one suffered an arrhythmic death. Intra-atrial re-entrant tachycardia and clinically relevant conduction disease were detected in patients irrespective of sudden cardiac death risk. CONCLUSION Continuous monitoring with an ILR in patients with systemic right ventricle following atrial switch detects clinically relevant arrhythmias that impact decision-making. In this cohort, clinically relevant arrhythmias did not correlate with sudden cardiac death risk.
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Affiliation(s)
- Jayant Kakarla
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - David S Crossland
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Stephen Murray
- Cardiology Department, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
| | - Kaitav Adhvaryu
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Justyna Rybicka
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Antony Hermuzi
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Ruairidh Martin
- Cardiology Department, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
| | - Ewen Shepherd
- Cardiology Department, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
| | - Neil Seller
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Louise Coats
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Creteanu A, Lisa G, Vasile C, Popescu MC, Spac AF, Tantaru G. Development of Solid Lipid Nanoparticles for Controlled Amiodarone Delivery. Methods Protoc 2023; 6:97. [PMID: 37888029 PMCID: PMC10609381 DOI: 10.3390/mps6050097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
In various drug delivery systems, solid lipid nanoparticles are dominantly lipid-based nanocarriers. Amiodarone hydrochloride is an antiarrhythmic agent used to treat severe rhythm disturbances. It has variable and hard-to-predict absorption in the gastrointestinal tract because of its low solubility and high permeability. The aims of this study were to improve its solubility by encapsulating amiodarone into solid lipid nanoparticles using two excipients-Compritol® 888 ATO (pellets) (C888) as a lipid matrix and Transcutol® (T) as a surfactant. Six types of amiodarone-loaded solid lipid nanoparticles (AMD-SLNs) were obtained using a hot homogenization technique followed by ultrasonication with varying sonication parameters. AMD-SLNs were characterized by their size distribution, polydispersity index, zeta potential, entrapment efficiency, and drug loading. Based on the initial evaluation of the entrapment efficiency, only three solid lipid nanoparticle formulations (P1, P3, and P5) were further tested. They were evaluated through scanning electron microscopy, Fourier-transform infrared spectrometry, near-infrared spectrometry, thermogravimetry, differential scanning calorimetry, and in vitro dissolution tests. The P5 formulation showed optimum pharmaco-technical properties, and it had the greatest potential to be used in oral pharmaceutical products for the controlled delivery of amiodarone.
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Affiliation(s)
- Andreea Creteanu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iași, Romania
| | - Gabriela Lisa
- Department of Chemical Engineering, Faculty of Chemical Engineering and Environmental Protection, "Gheorghe Asachi" Technical University, 73 Prof. Dr. Docent Dimitrie Mangeron Street, 700050 Iași, Romania
| | - Cornelia Vasile
- Physical Chemistry of Polymers Department, Petru Poni Institute of Macromolecular Chemistry, 41A Gr. Ghica Voda Alley, 700487 Iași, Romania
| | - Maria-Cristina Popescu
- Physical Chemistry of Polymers Department, Petru Poni Institute of Macromolecular Chemistry, 41A Gr. Ghica Voda Alley, 700487 Iași, Romania
| | - Adrian Florin Spac
- Department of Phisico Chemistry, Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iași, Romania
| | - Gladiola Tantaru
- Department of Analytical Chemistry, Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iași, Romania
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Hu TY, Janga C, Amin M, Tan NY, Hodge DO, Mehta RA, McLeod CJ, Chiriac A, Miranda WR, Connolly HM, Asirvatham SJ, Deshmukh AJ, Egbe AC, Madhavan M. Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes. Circ Arrhythm Electrophysiol 2023; 16:437-446. [PMID: 37485717 DOI: 10.1161/circep.122.011392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/27/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The outcomes of catheter ablation for atrial fibrillation in adults with congenital heart disease are not well described. METHODS In a retrospective study of adult patients with congenital heart disease who underwent catheter ablation for atrial fibrillation between 2000 and 2020 at Mayo Clinic, procedural characteristics and outcomes were collected. The primary outcomes were atrial arrhythmia (AA) recurrence following a 3-month blanking period and repeat ablation. An arrhythmia clinical severity score was assessed pre- and post-ablation based on the duration of arrhythmia episodes, symptoms, cardioversion frequency, and antiarrhythmic drug use. RESULTS One hundred forty-five patients (age, 57±12 years; 28% female; 63% paroxysmal atrial fibrillation) underwent 198 ablations with a median follow-up of 26 months (interquartile range, 14-69). One hundred ten, 26, and 9 patients had simple, moderate, and complex congenital heart disease, respectively. All patients underwent pulmonary vein isolation, and non-pulmonary vein targets were ablated in 79 (54%). AA recurrence at 12 months was 37% (95% CI, 29%-45%). On univariate analysis, increasing left atrial volume index was associated with higher odds of AA recurrence (odds ratio, 1.03 [1.00-1.06] per 1 mL/m2 increment; P=0.05). Noninducibility of atrial flutter was predictive of decreased odds of AA recurrence (odds ratio, 0.43 [0.21-0.90]; P=0.03). A second ablation was performed in 43 patients after a median of 20 (interquartile range, 8-37) months. Arrhythmia clinical severity scores improved following ablation, reflecting a decrease in symptoms, cardioversions, and antiarrhythmic drugs. CONCLUSIONS Catheter ablation of atrial fibrillation is feasible and effective in patients with adult congenital heart disease and reduces symptoms. Recurrence of AA frequently requires repeat ablation.
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Affiliation(s)
- Tiffany Y Hu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Chaitra Janga
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Mustapha Amin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (M.A.)
| | - Nicholas Y Tan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo College of Medicine, Jacksonville, FL (D.O.H.)
| | - Ramila A Mehta
- Department of Quantitative Health Sciences, Mayo College of Medicine, Rochester, MN (R.A.M.)
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic in Jacksonville, FL (C.J.M., A.C.)
| | - Anca Chiriac
- Department of Cardiovascular Diseases, Mayo Clinic in Jacksonville, FL (C.J.M., A.C.)
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Alexander C Egbe
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
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Gašparini D, Raljević D, Pehar-Pejčinović V, Klarica Gembić T, Peršić V, Turk Wensveen T. When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report. Front Cardiovasc Med 2023; 10:1212965. [PMID: 37547257 PMCID: PMC10401478 DOI: 10.3389/fcvm.2023.1212965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Amiodarone is a potent antiarrhythmic medication used to treat life-threatening ventricular arrhythmias; however, its well-established adverse effect is a thyroid disorder. Amiodarone-induced thyroiditis (AIT), a clinical entity involving two types with different etiopathology and treatment approaches, may occur at the beginning or even several years after amiodarone treatment discontinuation. The toxicity profile of amiodarone becomes especially important in young patients with lifelong cardiac disorders, which are often refractory to other antiarrhythmic drugs. Herein, we report the first case of non-sustained ventricular tachycardia (NSVT), an unusual presentation of type II AIT, in a young male patient who was previously diagnosed with left ventricular cardiomyopathy with excessive trabeculation. Case report A 36-year-old male non-athlete presented with tiredness during regular follow-up. Continuous electrocardiographic monitoring (cECG) revealed NSVT, whereas echocardiography and cardiac magnetic resonance imaging detected discrete structural and functional changes that could not fully explain the observed cECG report. Conversely, an unmeasurably low thyrotropin level on admission and previous exposure to amiodarone pointed the diagnostic pathway in the direction of the thyroid gland. Elevated free thyroxine and undetectable autoantibody titers with unremarkable sonographic findings raised clinical suspicion of type II AIT. Scintigraphic imaging with 99mTc-2-methoxyisobutylisonitrile (sestamibi) revealed decreased thyroid uptake; hence, prednisone was introduced for treatment. Clear improvements in both biochemical and electrocardiographic parameters were observed after immunomodulatory treatment of type II AIT in this young patient with cardiomyopathy and excessive trabeculation. Conclusion Treatment of reversible causes of cardiac rhythm abnormalities such as type II AIT should be considered before choosing other treatment modalities, particularly in patients with structural cardiac disorders. The importance of a multidisciplinary approach in complex cases such as the one reported, thus, cannot be emphasized enough.
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Affiliation(s)
- Dora Gašparini
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Center for Diabetes, Endocrinology and Cardiometabolism, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | - Damir Raljević
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | - Vesna Pehar-Pejčinović
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | | | - Viktor Peršić
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | - Tamara Turk Wensveen
- Center for Diabetes, Endocrinology and Cardiometabolism, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Endocrinology, Diabetes and Metabolic Diseases, Clinic of Internal Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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Perna F, Telesca A, Scacciavillani R, Narducci ML, Bencardino G, Pinnacchio G, Spera FR, Sabarese R, Comerci G, Pelargonio G. Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease. J Cardiovasc Dev Dis 2023; 10:jcdd10040168. [PMID: 37103047 PMCID: PMC10141040 DOI: 10.3390/jcdd10040168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of cardiac fibrosis in this setting has not been investigated. The aim of this study was to determine the role of the extension of cardiac fibrosis, detected by electroanatomical mapping, in predicting arrhythmia recurrencies after ablation in ACHD. MATERIALS AND METHODS Consecutive patients with congenital heart disease and atrial or ventricular arrhythmias undergoing catheter ablation were enrolled. An electroanatomical bipolar voltage map was performed during sinus rhythm in each patient and bipolar scar was assessed according to the current literature data. During follow-up, arrhythmia recurrences were recorded. The relationship between the extent of myocardial fibrosis and arrhythmia recurrence was assessed. RESULTS Twenty patients underwent successful catheter ablation of atrial (14) or ventricular (6) arrhythmias, with no inducible arrhythmia at the end of the procedure. During a median follow-up period of 207 weeks (IQR 80 weeks), eight patients (40%; five atrial and three ventricular arrhythmias) had arrhythmia recurrence. Of the five patients undergoing a second ablation, four showed a new reentrant circuit, while one patient had a conduction gap across a previous ablation line. The extension of the bipolar scar area (HR 1.049, CI 1.011-1.089, p = 0.011) and the presence of a bipolar scar area >20 cm2 (HR 6.101, CI 1.147-32.442, p = 0.034) were identified as predictors of arrhythmia relapse. CONCLUSION The extension of the bipolar scar area and the presence of a bipolar scar area >20 cm2 can predict arrhythmia relapse in ACHD undergoing catheter ablation of atrial and ventricular arrhythmias. Recurrent arrhythmias are often caused by circuits other than those previously ablated.
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Affiliation(s)
- Francesco Perna
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alessandro Telesca
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gaetano Pinnacchio
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Raffaele Spera
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Rocco Sabarese
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluca Comerci
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gemma Pelargonio
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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Biakina O, Mitina Y, Gognieva D, Axenova M, Ermolaeva A, Bestavashvili A, Fadeev V, Syrkin A, Kopylov P. DUOX1 Gene Missense Mutation Confers Susceptibility on Type 2 Amiodarone-Induced Thyrotoxicosis. Int J Mol Sci 2023; 24:ijms24044016. [PMID: 36835420 PMCID: PMC9964217 DOI: 10.3390/ijms24044016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Possible triggers and genetic markers involved in pathogenesis of amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) are currently unknown. This study aimed to analyze the association between polymorphisms in the genes involved in thyroid hormones biosynthesis and metabolism. Thirty-nine consecutive patients with confirmed type 2 amiodarone-induced thyrotoxicosis were enrolled; 39 patients on the same therapy for at least 6 months without thyroid pathology were included as a control group. A comparative study was carried out to determine the distribution and genotypes of polymorphic markers of the (Na)-iodide symporter (NIS) genes (rs7250346, C/G substitution), thyroid stimulating hormone receptor (TSHR) (rs1991517, C/G substitution), thyroid peroxidase (TPO) (rs 732609, A/C substitution), DUOX 1-1 (C/T substitution), DUOX 1-2 (G/T substitution), DUOX 1-3 (C/T substitution), glutathione peroxidase 3 (GPX3) (C/T substitution), glutathione peroxidase 4 (GPX4) (C/T substitution). Statistical analysis was performed using Prism (Version 9.0.0 (86)). This study showed that the risk of AIT2 is 3.18 times higher in the G/T of the DUOX1 gene carriers. This study is the first report of genetic markers associated with amiodarone-related adverse events conducted in humans. The obtained results indicate the necessity for a personalized approach to amiodarone administration.
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Affiliation(s)
- Olga Biakina
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Yulia Mitina
- Department of Anatomy and Physiology, School of Biomedical Sciences, University of Melbourne, Melbourne 3010, Australia
- Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Daria Gognieva
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- World-Class Research Center «Digital Biodesign and Personalized Healthcare», I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Marina Axenova
- Federal State Organization “Centre for Strategic Planning and Management of Biomedical Health Risks”, Ministry of Health of the Russian Federation, 119121 Moscow, Russia
| | - Alexandra Ermolaeva
- Department of Endocrinology No. 1 of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Afina Bestavashvili
- World-Class Research Center «Digital Biodesign and Personalized Healthcare», I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Correspondence: ; Tel.: +7-916-338-35-95
| | - Valentin Fadeev
- Department of Endocrinology No. 1 of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Abram Syrkin
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Philipp Kopylov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- World-Class Research Center «Digital Biodesign and Personalized Healthcare», I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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10
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CLInical Profile and Side Effects of chronic use of oral Amiodarone in cardiology outpatients department (CLIPSE-A Study)- A prospective observational study. Ann Med Surg (Lond) 2022; 80:104167. [PMID: 36045807 PMCID: PMC9422214 DOI: 10.1016/j.amsu.2022.104167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Amiodarone belongs to Class-III anti-arrhythmic drugs. It is one of the most effective anti-arrhythmic drugs used to treat or prevent several types of arrhythmias including atrial fibrillation, atrial flutter, ventricular tachycardia, and wide complex tachycardia, but unfortunately carries a high toxicity profile. Also, side effects of amiodarone involving various organs can be life-threatening. Materials & methods This was an observational study carried out for six months i.e from April to September. The study included patients who are on amiodarone for greater than or equal to six months. The required data was collected in-person from the case sheets, treatment charts, and by interviewing the patients. The data for 67 patients was documented in suitable data collection form for analysis. Results From our study data, it was noted that amiodarone was used for 3 different indications-atrial fibrillation, atrial flutter, and ventricular tachycardia. Among 67 patients enrolled, 38 had no side-effects. Side-effects data in the rest grouped basing on the organ system affected: 9 patients had renal effects, 6 patients had ophthalmic effects, 4 patients had endocrine effects, and 5 patients had hepatic effects. Conclusion From our study, it is concluded that amiodarone is a safe and effective anti-arrhythmic drug at lower doses i.e. 200-1100 mg/week. When treated in lower doses of 1400–2800 mg/week, many side effects have been incident. Although these effects are mild and develop only after prolonged usage of the drug, it should be used judiciously. Amiodarone has an unusual spectrum of side effects with a prevalence of 15% in the first year, increasing up to 50% during long-term use. Our study demonstrated amiodarone does not produce significant side-effects when used in doses of 200–1100 mg/week. Few side-effects are observed when amiodarone is used in higher doses of 1200–2800 mg/week. When a side-effect is observed, mere reducing the dose or withdrawal of drug might help. In most of the cases of atrial fibrillation, amiodarone is discontinued or altered in first year of treatment basing on risk/benefit ratio.
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11
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Fischer AJ, Enders D, Eckardt L, Köbe J, Wasmer K, Breithardt G, De Torres Alba F, Kaleschke G, Baumgartner H, Diller GP. Thyroid Dysfunction under Amiodarone in Patients with and without Congenital Heart Disease: Results of a Nationwide Analysis. J Clin Med 2022; 11:jcm11072027. [PMID: 35407633 PMCID: PMC8999848 DOI: 10.3390/jcm11072027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Amiodarone has a profound adverse toxicity profile. Large population-based analyses quantifying the risk of thyroid dysfunction (TD) in adults with and without congenital heart disease (ACHD) are lacking. Methods: All adults registered with a major German health insurer (≈9.2 million members) with amiodarone prescriptions were analyzed. Occurrence of amiodarone-associated TD was assessed. Results: Overall, 48,891 non-ACHD (37% female; median 73 years) and 886 ACHD (34% female; median 66 years) received amiodarone. Over 184,787 patient-years, 10,875 cases of TD occurred. The 10-year risk for TD was 38% in non-ACHD (35% ACHD). Within ACHD, compared to amiodarone-naïve patients, the hazard ratio (HR) for TD was 3.9 at 4 years after any amiodarone exposure. TD was associated with female gender (HR 1.42, p < 0.001) and younger age (HR 0.97 per 10 years, p = 0.009). Patients with congenital heart disease were not at increased risk (HR 0.98, p = 0.80). Diagnosis of complex congenital heart disease, however, was a predictor for TD (HR 1.56, p = 0.02). Amiodarone was continued in 47% of non-ACHD (38% ACHD), and 2.3% of non-ACHD (3.5% ACHD) underwent thyroid surgery/radiotherapy. Conclusions: Amiodarone-associated TD is common and comparable in non-ACHD and ACHD. While female gender and younger age are predictors for TD, congenital heart disease is not necessarily associated with an elevated risk.
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Affiliation(s)
- Alicia Jeanette Fischer
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, D-48149 Muenster, Germany; (G.B.); (F.D.T.A.); (G.K.); (H.B.); (G.-P.D.)
- Correspondence:
| | - Dominic Enders
- Institute of Biostatistics and Clinical Research, University Hospital Muenster, D-48149 Muenster, Germany;
| | - Lars Eckardt
- Department of Cardiology II—Electrophysiology, University Hospital Muenster, D-48149 Muenster, Germany; (L.E.); (J.K.); (K.W.)
| | - Julia Köbe
- Department of Cardiology II—Electrophysiology, University Hospital Muenster, D-48149 Muenster, Germany; (L.E.); (J.K.); (K.W.)
| | - Kristina Wasmer
- Department of Cardiology II—Electrophysiology, University Hospital Muenster, D-48149 Muenster, Germany; (L.E.); (J.K.); (K.W.)
| | - Günter Breithardt
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, D-48149 Muenster, Germany; (G.B.); (F.D.T.A.); (G.K.); (H.B.); (G.-P.D.)
| | - Fernando De Torres Alba
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, D-48149 Muenster, Germany; (G.B.); (F.D.T.A.); (G.K.); (H.B.); (G.-P.D.)
| | - Gerrit Kaleschke
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, D-48149 Muenster, Germany; (G.B.); (F.D.T.A.); (G.K.); (H.B.); (G.-P.D.)
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, D-48149 Muenster, Germany; (G.B.); (F.D.T.A.); (G.K.); (H.B.); (G.-P.D.)
| | - Gerhard-Paul Diller
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, D-48149 Muenster, Germany; (G.B.); (F.D.T.A.); (G.K.); (H.B.); (G.-P.D.)
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12
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Mohammadi K, Shafie D, Vakhshoori M, Bondariyan N, Heidarpour M, Rezvanian H. Prevalence of amiodarone-induced hypothyroidism; A systematic review and meta-analysis: Amiodarone-induced hypothyroidism epidemiology. Trends Cardiovasc Med 2022; 33:252-262. [PMID: 35026394 DOI: 10.1016/j.tcm.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
Amiodarone is a common anti-arrhythmic agent mostly used to treat and prevent different kinds of arrhythmia with several considerable side effects, most commonly on the thyroid gland. We aimed to assess the frequency of hypothyroidism among chronic amiodarone users. PubMed/Medline, Web of Science, and Scopus databases were screened in the title and abstract sections with no time limitation. Relevant published records reported amiodarone-induced hypothyroidism (AIH) among patients with normal thyroid function at baseline were recruited with further analysis according to gender and study locations. We found 29 records on 14143 individuals. Total population age ranged from 18 to 92 years (males: 58.2% (8158 out of 13999)). The AIH prevalence was found to be 14% (95% confidence interval (CI): 12-17%). Further gender stratified showed an insignificant higher AIH frequency in females versus males (17%, 95% CI: 13-22% vs. 14%, 95% CI: 11-19% P= 0.304, respectively). Despite no significant difference in AIH prevalence according to different continents, African subjects had marginally lower AIH frequency compared to Asian (7%, 95% CI: 4-13% vs. 15%, 95% CI: 12-19%, P= 0.012) and South American persons (7%, 95% CI: 4-13% vs. 54%, 95% CI: 9-93%, P= 0.038). This review suggests the occurrence of AIH is quite considerable regardless of gender and area of residence, and several periodic thyroid assessment strategies should be developed for earlier recognition and therapeutic interventions in clinical settings.
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Affiliation(s)
- Keivan Mohammadi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Davood Shafie
- Assistant Professor, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Maryam Heidarpour
- Assistant Professor of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hassan Rezvanian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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13
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Hashimoto N, Doki K, Kawano S, Aonuma K, Ieda M, Homma M. Increased serum amiodarone concentration in hypertriglyceridemic patients: Effects of drug distribution to serum lipoproteins. Clin Transl Sci 2021; 15:771-781. [PMID: 34786846 PMCID: PMC8932714 DOI: 10.1111/cts.13199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022] Open
Abstract
Amiodarone and its main metabolite, desethylamiodarone (DEA), are highly distributed to serum lipoproteins such as very‐low‐density lipoprotein (VLDL) and low‐density lipoprotein (LDL), which are the carriers of triglyceride and cholesterol. This study aimed to investigate the association of serum concentrations of amiodarone and DEA with the levels of serum lipids in terms of drug distribution to lipoprotein fractions in patients with hyperlipidemia. Total serum concentrations of amiodarone and DEA were examined in 116 patients receiving amiodarone for tachyarrhythmias. The concentration‐to‐dose (C/D) ratio of amiodarone positively correlated with the level of serum triglyceride (rs = 0.541, p < 0.001) and was higher in the hypertriglyceridemic state than in normotriglyceridemic state (479 ± 211 vs. 320 ± 161, p < 0.001). No correlation was found between the C/D ratio of DEA and serum triglyceride levels (rs = 0.272), although higher values were observed in the hypertriglyceridemic state (322 ± 125 vs. 285 ± 143, p < 0.001). In the hypertriglyceridemic state, the distribution of amiodarone increased in LDL/VLDL fraction and decreased in high‐density lipoprotein and albumin fractions. The ratio of serum amiodarone to serum DEA, a metabolic ratio of amiodarone, positively correlated with serum triglyceride levels (rs = 0.572, p < 0.001) and was higher in the hypertriglyceridemic state, suggesting that amiodarone metabolism decreased in hyperlipidemia. The results of this study reveal that serum concentrations of amiodarone increase in the hypertriglyceridemic state through the increased lipoprotein‐binding and decreased metabolism of amiodarone.
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Affiliation(s)
- Naoaki Hashimoto
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Doki
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoru Kawano
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masato Homma
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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14
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Mahadevappa M, Jodiya A, Chalasani SH, Syed JM, Ramesh M, Pereira P. Amiodarone-Induced Hyponatremia in An Elderly Patient: A Rare Case Report. J Pharm Pract 2021; 36:695-698. [PMID: 34715751 DOI: 10.1177/08971900211054199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Amiodarone is an antiarrhythmic drug belonging to Vaughan-Williams Class III with additional Class IV effects, which is known to cause many adverse drug reactions (ADRs) necessitating close monitoring. In about 20% of patients, their therapy is discontinued due to adverse effects such as hepatic impairment, thyroid dysfunction, and several pulmonary complications. Although dyselectrolytemia is a common adverse reaction reported with many cardiac medications, the incidence of hyponatremia associated with amiodarone intake is not reported widely in the literature.We are reporting a case of a 73-year-old female patient, with hypertension and ischemic heart disease (IHD) receiving oral amiodarone, presenting with severe hyponatremia, requiring recurrent hospitalization. Amiodarone was found to be responsible after evaluating for the possible causes of hyponatremia.As the incidence of amiodarone-associated hyponatremia is unknown, and not many cases are reported, this case report serves to sensitize the clinician to consider amiodarone-induced hyponatremia as one of the differential diagnoses in cases of unexplained hyponatremia.
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Affiliation(s)
- Manjappa Mahadevappa
- Department of Cardiology, 29241JSS Medical College & Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Annet Jodiya
- Department of Pharmacy Practice, 75532JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | - Sri Harsha Chalasani
- Department of Pharmacy Practice, 75532JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | - Jehath M Syed
- Department of Pharmacy Practice, 75532JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | - Madhan Ramesh
- Department of Pharmacy Practice, 75532JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | - Prathibha Pereira
- Department of Geriatric Medicine, 29241JSS Medical College & Hospital, JSS Academy of Higher Education and Research, Mysore, India
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15
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Kawada S, Chakraborty P, Roche L, Oechslin EN, Silversides C, Wald RM, Downar E, Harris L, Swan L, Alonso-Gonzalez R, Thorne S, Yamamura K, Nanthakumar K, Mondésert B, Khairy P, Nair K. Role of amiodarone in the management of atrial arrhythmias in adult Fontan patients. Heart 2021; 107:1062-1068. [PMID: 33115764 DOI: 10.1136/heartjnl-2020-317378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with Fontan circulation are known to be at high risk for developing atrial tachyarrhythmias (AAs). Our objective was to examine the efficacy and safety of amiodarone in the management of ATs in adult Fontan patients. METHODS Primary outcomes of this single-centre, retrospective study included freedom from AAs and incidence of adverse effects of amiodarone on Fontan patients. Heart failure (HF) events and composite outcomes of death from any cause, Fontan revision and heart transplantation were evaluated as secondary outcomes. Predictors of HF and discontinuing amiodarone were also evaluated. RESULTS A total of 61 patients (mean age 31.6±11.3 years, 40.9% female), who were treated with amiodarone in between 1995 and 2018, were included. AAs free survival at 1, 3 and 5 years were 76.2%, 56.9% and 30.6%, respectively. During a median follow-up of 50.5 months, 34 (55.7%) patients developed side effects, and 20 (32.8%) patients discontinued amiodarone due to side effects. Thyroid dysfunction was the most common side effect (n=26, 76.5%), amiodarone-induced thyrotoxicosis (AIT) (n=16, 27.1%) being most common thyroid dysfunction. Young age (age <28.5 years) was associated with discontinuing amiodarone (HR 5.50, 95% CI 1.19 to 25.4, p=0.029). AIT significantly increased risk of HF (HR 4.82, 95% CI 1.71 to 13.6, p=0.003). CONCLUSIONS Short-term efficacy of amiodarone in Fontan physiology is acceptable. However, long-term administration is associated with a reduction of efficacy and a significant prevalence of non-cardiac side effects. AIT is associated with exacerbation of HF. The judicious use of amiodarone administration should be considered in this population.
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Affiliation(s)
- Satoshi Kawada
- Electrophysiology department, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Praloy Chakraborty
- Electrophysiology department, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lucy Roche
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Erwin N Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Candice Silversides
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eugene Downar
- Electrophysiology department, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Louise Harris
- Electrophysiology department, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lorna Swan
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Sara Thorne
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kenichiro Yamamura
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Electrophysiology department, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Blandine Mondésert
- Electrophysiology Service and Adult Congenital Heart Disease, Department of Medicine, Montreal Heart Instiutue, Montreal, Quebec, Canada
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease, Department of Medicine, Montreal Heart Instiutue, Montreal, Quebec, Canada
| | - Krishnakumar Nair
- Electrophysiology department, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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16
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Abstract
A Fontan circulation requires a series of three-staged operations aimed to palliate patients with single-ventricle CHD. Currently, the most frequent technique is the extracardiac total cavopulmonary connection, an external conduit connecting the IVC and right pulmonary artery, bypassing the right side of the heart. Fontan candidates must meet strict criteria; they are assessed utilising both cardiac catheterisation and cardiac magnetic resonance. Postoperatively, treatment protocols prioritise antibiotic prophylaxis, diuretics, angiotensin-converting enzyme inhibitors, anticoagulation, and oxygen therapy with fluid restriction and a low-fat diet. These measures aim to reduce length of stay in the ICU and hospital by preventing acute complications such as infection, venous thromboembolism, low cardiac output, pleural effusion, and acute kidney injury. Late complications of a Fontan procedure include circulation failure, protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease. The definitive management is cardiac transplantation, with promising innovations in selective embolisation of lymphatic vessels and Fontan-specific ventricular assist devices. Further research assessing current protocols in the perioperative management of Fontan patients would be beneficial for standardising current practice and improving outcomes.
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17
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de Miguel IM, Ávila P. Atrial Fibrillation in Congenital Heart Disease. Eur Cardiol 2021; 16:e06. [PMID: 33737960 PMCID: PMC7967824 DOI: 10.15420/ecr.2020.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/08/2020] [Indexed: 01/25/2023] Open
Abstract
The increasing prevalence of AF in a growing population of adults with congenital heart disease (CHD) poses new challenges to clinicians involved in the management of these patients. Distinctive underlying anatomies, unique physiological aspects, a high diversity of corrective surgeries and associated comorbidities can complicate clinical decision-making. In this review, the authors provide an overview of the current knowledge on epidemiology and pathophysiology, with a special focus on the differences to the non-CHD population and the clinical impact of AF in adults with CHD. Acute and long-term management strategies are summarised, including the use of antiarrhythmic drugs, catheter or surgical ablation and prophylaxis of thromboembolism. Finally, gaps of knowledge and potential areas of future research are highlighted.
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Affiliation(s)
- Irene Martín de Miguel
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
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18
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Westhoff-Bleck M. Moderne Herzinsuffizienztherapie bei Erwachsenen mit angeborenen Herzfehlern. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-020-00407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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The Role of Ablation in Prevention of Recurrent Implantable Cardioverter Defibrillator Shocks in Patients With Tetralogy of Fallot. CJC Open 2021; 3:619-626. [PMID: 34027366 PMCID: PMC8134918 DOI: 10.1016/j.cjco.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background Implantable cardioverter defibrillators (ICDs) are effective in preventing arrhythmic sudden cardiac death in patients with tetralogy of Fallot (TOF). Although ICD therapies for malignant ventricular arrhythmias can be life-saving, shocks could have deleterious consequences. Substrate-based ablation therapy has become the standard of care to prevent recurrent ICD shocks in patients with ischemic cardiomyopathy. However, the efficacy and safety of this invasive therapy in the prevention of recurrent ICD shocks in patients with TOF has not been well evaluated. Methods Records of a total of 47 consecutive TOF patients (mean age: 43.1 ± 13.2 years, male sex: n = 34 [72.3%]) who underwent ICD implantation for secondary prevention between 2000 and 2018 were reviewed. Results Twenty (42.6%) patients underwent invasive therapy (radiofrequency catheter ablation, n = 8; surgical ablation with pulmonary valve replacement, n = 12) before ICD implantation. Twenty-seven patients (57.4%) were managed noninvasively. During follow-up (median 80.5 [interquartile range, 28.5-131.0] months), 2 (10.0%) patients in the invasive group and 10 (37.0%) patients in the noninvasive group received appropriate ICD shocks (P = 0.036). Logistic regression analysis showed that invasive therapy was associated with a decreased risk of ICD shocks by 81.1% (odds ratio, 0.189; 95% confidence interval, 0.036-0.990; P = 0.049). Furthermore, invasive therapy was associated with decreased risk of the composite outcomes of ICD shock, death, cardiac transplantation, and hospital admission (odds ratio, 0.090; 95% confidence interval, 0.025-0.365; P = 0.013) compared with noninvasive therapy. Conclusions Invasive substrate modification therapy was associated with a lower likelihood of ICD shocks and improvement of long-term outcomes in TOF patients.
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El-Asmar JM, Naja AS, Al-Halabi E. Surgical Treatment of Amiodarone-Induced Thyrotoxicosis in an Adult with Congenital Heart Disease: An Anesthetists Perspective. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e917350. [PMID: 32024812 PMCID: PMC7020752 DOI: 10.12659/ajcr.917350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 19-year-old Final Diagnosis: Amiodarone induced thyrotoxicosis Symptoms: Tachycardia Medication:— Clinical Procedure: Total thyroidectomy Specialty: Anesthesiology
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Affiliation(s)
- Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Salaheddine Naja
- Division of Orthopedics, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eliane Al-Halabi
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
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Zentner D, Celermajer DS, Gentles T, d’Udekem Y, Ayer J, Blue GM, Bridgman C, Burchill L, Cheung M, Cordina R, Culnane E, Davis A, du Plessis K, Eagleson K, Finucane K, Frank B, Greenway S, Grigg L, Hardikar W, Hornung T, Hynson J, Iyengar AJ, James P, Justo R, Kalman J, Kasparian N, Le B, Marshall K, Mathew J, McGiffin D, McGuire M, Monagle P, Moore B, Neilsen J, O’Connor B, O’Donnell C, Pflaumer A, Rice K, Sholler G, Skinner JR, Sood S, Ward J, Weintraub R, Wilson T, Wilson W, Winlaw D, Wood A. Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement. Heart Lung Circ 2020; 29:5-39. [DOI: 10.1016/j.hlc.2019.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
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Ruzieh M, Moroi MK, Aboujamous NM, Ghahramani M, Naccarelli GV, Mandrola J, Foy AJ. Meta-Analysis Comparing the Relative Risk of Adverse Events for Amiodarone Versus Placebo. Am J Cardiol 2019; 124:1889-1893. [PMID: 31653351 DOI: 10.1016/j.amjcard.2019.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022]
Abstract
Amiodarone has been associated with adverse events that may restrict its use. We performed a meta-analysis of placebo-controlled trials to assess the relative risk of adverse events of amiodarone compared with placebo. In total, 43 randomized trials were included. A total of 11,395 patients were included (5,792 patients randomized to amiodarone and 5,603 patients randomized to placebo). The incident rate of adverse events per 10,000 person-years was higher in the amiodarone group compared with placebo for pulmonary (129 vs 74; relative risk (RR) 1.77, p = 0.002), thyroid (201 vs 42; RR 4.44, p <0.001), hepatic (54 vs 25; RR 2.27, p = 0.01), cardiac (771 vs 450; RR 1.94, p <0.001), neurological (140 vs 76; RR 1.93, p <0.001), and skin (81 vs 23; RR 1.99, p = 0.04) adverse events. Low-dose amiodarone was not associated with statistically significant increase in pulmonary adverse events but was still associated with thyroid and liver adverse events. In conclusion, the likelihood of experiencing adverse events related to amiodarone was higher than that of placebo. The overall rate of adverse events however, was low, and severe adverse events were rare.
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Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:44. [PMID: 31342289 DOI: 10.1007/s11936-019-0749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
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