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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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Saengklub N, Limprasutr V, Sawangkoon S, Hamlin RL, Kijtawornrat A. Dronedarone attenuates the duration of atrial fibrillation in a dog model of sustained atrial fibrillation. Exp Anim 2017; 66:251-258. [PMID: 28381818 PMCID: PMC5543246 DOI: 10.1538/expanim.17-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrillation (AF) is a supraventricular arrhythmia that leads to a decrease in
cardiac output and impairs cardiac function and quality of life. Dronedarone has an
atrial-selective property and has been used for management of AF in humans, but limited
information is available in dogs. This study was designed to evaluate efficacy of
dronedarone in attenuating the duration of AF in dog model of sustained AF. Six beagle
dogs were anesthetized with isoflurane and instrumented to measure atrial action potential
duration (aAPD) and atrial effective refractory period (AERP). Then AF was induced by
rapid right atrial pacing (20 V, 40 Hz) simultaneously with infusion of phenylephrine (2
µg/kg/min, intravenously) for 20 min. The duration of sustained AF was
recorded, and the animals were allowed to recover. Dronedarone was given at a dose of 20
mg/kg, BID, orally for 7 days. On the last day, the dogs were anesthetized again to record
aAPD and AERP, and AF was induced with the same procedure as described above. The results
showed that after dronedarone administration the aAPD was lengthened significantly from
76.4 ± 4.2 ms to 91.2 ± 3.9 ms (P<0.05) and AERP was prolonged
significantly from 97.5 ± 2.8 ms to 120 ± 4.8 ms (P<0.05). The
duration of sustained AF was also significantly attenuated after receipt of dronedarone
(P<0.05). It can be suggested that oral dronedarone attenuates the
duration of sustained AF in a dog model of AF by extending the AERP more than the aAPD,
causing post-repolarization refractoriness. Hence, dronedarone may be useful for
management of AF in dogs.
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Affiliation(s)
- Nakkawee Saengklub
- Animal Physiology Program, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Vudhiporn Limprasutr
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Suwanakiet Sawangkoon
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Robert L Hamlin
- QTest Labs, Ltd., 6456 Fiesta Drive, Columbus, Ohio 43235, USA
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand.,Research clusters: research study and testing of drug's effect related to cardiovascular system in laboratory animal, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
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Rizkallah J, Kuriachan V, Brent Mitchell L. The use of dronedarone for recurrent ventricular tachycardia: a case report and review of the literature. BMC Res Notes 2016; 9:370. [PMID: 27461025 PMCID: PMC4962476 DOI: 10.1186/s13104-016-2116-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background Dronedarone is a benzofuran derivative resembling amiodarone that was intended to reduce the iodine-associated tissue deposition and organ toxicity seen with the latter. The utility of dronedarone for patients with ventricular arrhythmias has not been thoroughly evaluated. We present our experience with its use to treat refractory ventricular tachycardia storm and review the literature. Case presentation An 85 year-old gentleman with multiple medical comorbidities including ischemic and non-ischemic cardiomyopathy with severe biventricular systolic dysfunction presented with ventricular tachycardia storm. Therapeutic options were limited given his frail medical status, failures of sotalol, mexilitine, and catheter ablation therapies along with drug-toxicities from amiodarone. Dronedarone was thus considered as off-label use following informed consent. The patient unfortunately developed fatal multisystem organ failure including acute severe hepatotoxicity from dronedarone. Conclusion Novel therapies for drug-refractory ventricular arrhythmias are long overdue given the limitations of available pharmacologic and non-pharmacologic options. Off-label use of antiarrhythmic agents such as dronedarone is considered a treatment of last-resort in patients who otherwise have no therapeutic options. Given the paucity of reported cases regarding dronedarone for the treatment of ventricular tachyarrhythmias, no conclusive recommendations can be made at this time aside from words of caution. Despite the potential ventricular antiarrhythmic effects of dronedarone, careful patient evaluation is required to identify those at greatest risk of drug-related adverse events particularly in those patients with significant comorbidities such as advanced hepatic, renal, and cardiovascular disease.
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Affiliation(s)
- Jacques Rizkallah
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Vikas Kuriachan
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - L Brent Mitchell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada. .,C829 Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
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Saengklub N, Youngblood B, Del Rio C, Sawangkoon S, Hamlin RL, Kijtawornrat A. Short-term effects of oral dronedarone administration on cardiac function, blood pressure and electrocardiogram in conscious telemetry dogs. J Vet Med Sci 2016; 78:977-85. [PMID: 26922916 PMCID: PMC4937158 DOI: 10.1292/jvms.15-0481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dronedarone is a multichannel blocking antiarrhythmic drug that has been used for management of atrial
fibrillation in humans, but the data in veterinary medicine are inadequate. The objective of this study was to
determine the short-term effects of oral dronedarone on cardiac inotropy and lusitropy, blood pressure and
electrocardiogram (ECG) in healthy dogs. A total of 6 beagle dogs were instrumented with telemetry units and
sono-micrometry crystals to obtain left ventricular pressure-volume relationship, mean blood pressure (MBP)
and ECG. Dogs were given orally dronedarone (20 mg/kg, twice per day) for 7 days. All parameters were obtained
hourly at 4–8 hr after the first dose and at 12-, 96- (day 4) and 168-hr (day 7) after dosing. The results
showed that dronedarone had no effect on inotropy and lusitropy, while it significantly lengthened PQ interval
(P<0.001) and lowered MBP (P<0.05). Dronedarone also tended to
reduce cardiac output (P=0.237) and heart rate (P=0.057). These results
suggested that short-term effects of oral dronedarone administration at a dose of 20 mg/kg, twice per day,
produced negative dromotropy with minimal effect on cardiac function in conscious dogs.
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Affiliation(s)
- Nakkawee Saengklub
- Graduate Student in the Program of Animal Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
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Williams ES, Viswanathan MN. Current and emerging antiarrhythmic drug therapy for ventricular tachycardia. Cardiol Ther 2013; 2:27-46. [PMID: 25135287 PMCID: PMC4107437 DOI: 10.1007/s40119-013-0012-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Indexed: 12/14/2022] Open
Abstract
Ventricular arrhythmias, including ventricular fibrillation (VF) and sustained ventricular tachycardia (VT), are the principal causes of sudden cardiac death in patients with structural heart disease. While coronary artery disease is the predominant substrate associated with the development of VT, these arrhythmias are known to occur in a variety of disorders, including dilated cardiomyopathy, valvular and congenital heart disease, and cardiac ion channelopathies such as the long QT syndrome. In a minority of patients, VT occurs in the absence of structural heart disease. Despite the established mortality benefit of the implantable cardioverter defibrillator (ICD) in patients at risk of lethal arrhythmias, recurrent VT/VF events continue to be a source of morbidity and impaired quality of life in such patients. Antiarrhythmic therapy is indicated in select patients to treat symptomatic VT episodes, to reduce the incidence of ICD shocks, and potentially to improve quality of life and reduce hospitalizations related to cardiac arrhythmia. The primary adverse effects of antiarrhythmic medications are related to both cardiac and extracardiac toxicity, including the risk of proarrhythmia. Current drug therapy for ventricular arrhythmia has been limited by suboptimal efficacy in many patients, resulting in recurrent VT/VF events, and by drug toxicity or intolerance leading to discontinuation in a large percentage of patients. Amiodarone and sotalol are the principal agents used in the chronic treatment of VT. In addition, dronedarone and dofetilide, agents approved for the treatment of atrial fibrillation, and ranolazine, an antianginal agent, have been demonstrated to be protective against ventricular arrhythmia in small clinical studies. Finally, advances in basic electrophysiology have uncovered new molecular targets for the treatment of ventricular arrhythmia, and pharmacologic agents directed at these targets may emerge as promising VT treatments in the future. The roles of these current and emerging therapies for the treatment of VT in humans will be summarized in this review.
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Affiliation(s)
- Eric S Williams
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA,
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Exposito V, Rodriguez-Entem F, Gonzalez-Enriquez S, Olalla JJ. Dronedarone for recurrent ventricular tachycardia: a real alternative? Indian Pacing Electrophysiol J 2012; 12:73-6. [PMID: 22557846 PMCID: PMC3337372 DOI: 10.1016/s0972-6292(16)30483-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sustained ventricular tachycardia (VT) is an important cause of morbidity and sudden death in patients with dilated cardiomyopathy. Although ICD effectively terminate VT episodes and improve survival, shocks reduce quality of life, and episodes of VT predict increased risk of heart failure and death despite effective therapy. Patients suffering recurrent VT episodes remain a challenge. Antiarrhytmic therapy reduces VT episodes, but it is associated with serious adverse events, and disappointing efficacy. Catheter ablation has emerged as an important option to control recurrent VT, but major procedure-related complications, and even death, are still issues to concern. And even with these armamentaria, some patients still have recurrent VT episodes and ICD shocks. We report on a patient with non-ischemic dilated cardiomyopathy and recurrent ventricular tachycardia resistant to multiple antiarrhytmic agents, in whom dronedarone was effective in completely suppressing ventricular tachycardia episodes.
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Affiliation(s)
- Victor Exposito
- Arrhytmia Unit. Cardiology Service. Universitary Hospital Marques de Valdecilla. Santander. Spain
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Naccarelli GV, Wolbrette DL, Levin V, Samii S, Banchs JE, Penny-Peterson E, Gonzalez MD. Safety and efficacy of dronedarone in the treatment of atrial fibrillation/flutter. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2011; 5:103-19. [PMID: 22084608 PMCID: PMC3201110 DOI: 10.4137/cmc.s6677] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Dronedarone is an amiodarone analog but differs structurally from amiodarone in that the iodine moiety was removed and a methane-sulfonyl group was added. These modifications reduced thyroid and other end-organ adverse effects and makes dronedarone less lipophilic, shortening its half-life. Dronedarone has been shown to prevent atrial fibrillation/flutter (AF/AFl) recurrences in several multi-center trials. In addition to its rhythm control properties, dronedarone has rate control properties and slows the ventricular response during AF. Dronedarone is approved in Europe for rhythm and rate control indications. In patients with decompensated heart failure, dronedarone treatment increased mortality and cardiovascular hospitalizations. However, when dronedarone was used in elderly high risk AF/AFl patients excluding such high risk heart failure, cardiovascular hospitalizations were significantly reduced and the drug was approved in the USA for this indication in 2009 by the Food and Drug Administration. Updated guidelines suggest dronedarone as a front-line antiarrhythmic in many patients with AF/Fl but caution that the drug should not be used in patients with advanced heart failure. In addition, the recent results of the PALLAS trial suggest that dronedarone should not be used in the long-term treatment of patients with permanent AF.
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Affiliation(s)
- Gerald V Naccarelli
- Penn State Hershey Heart and Vascular Institute, Cardiac Electrophysiology Program, Hershey, PA, USA
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