1
|
Coult J, Yang BY, Kwok H, Kutz JN, Boyle PM, Blackwood J, Rea TD, Kudenchuk PJ. Prediction of Shock-Refractory Ventricular Fibrillation During Resuscitation of Out-of-Hospital Cardiac Arrest. Circulation 2023; 148:327-335. [PMID: 37264936 DOI: 10.1161/circulationaha.122.063651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation (VF) is associated with relatively poor survival. The ability to predict refractory VF (requiring ≥3 shocks) in advance of repeated shock failure could enable preemptive targeted interventions aimed at improving outcome, such as earlier administration of antiarrhythmics, reconsideration of epinephrine use or dosage, changes in shock delivery strategy, or expedited invasive treatments. METHODS We conducted a cohort study of VF out-of-hospital cardiac arrest to develop an ECG-based algorithm to predict patients with refractory VF. Patients with available defibrillator recordings were randomized 80%/20% into training/test groups. A random forest classifier applied to 3-s ECG segments immediately before and 1 minute after the initial shock during cardiopulmonary resuscitation was used to predict the need for ≥3 shocks based on singular value decompositions of ECG wavelet transforms. Performance was quantified by area under the receiver operating characteristic curve. RESULTS Of 1376 patients with VF out-of-hospital cardiac arrest, 311 (23%) were female, 864 (63%) experienced refractory VF, and 591 (43%) achieved functional neurological survival. Total shock count was associated with decreasing likelihood of functional neurological survival, with a relative risk of 0.95 (95% CI, 0.93-0.97) for each successive shock (P<0.001). In the 275 test patients, the area under the receiver operating characteristic curve for predicting refractory VF was 0.85 (95% CI, 0.79-0.89), with specificity of 91%, sensitivity of 63%, and a positive likelihood ratio of 6.7. CONCLUSIONS A machine learning algorithm using ECGs surrounding the initial shock predicts patients likely to experience refractory VF, and could enable rescuers to preemptively target interventions to potentially improve resuscitation outcome.
Collapse
Affiliation(s)
- Jason Coult
- Department of Medicine (J.C., T.D.R.), University of Washington, Seattle
| | - Betty Y Yang
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (B.Y.Y.)
| | - Heemun Kwok
- Department of Applied Mathematics (J.N.K.), University of Washington, Seattle
| | - J Nathan Kutz
- Department of Applied Mathematics (J.N.K.), University of Washington, Seattle
| | - Patrick M Boyle
- Department of Bioengineering (P.M.B.), University of Washington, Seattle
- Institute for Stem Cell and Regenerative Medicine (P.M.B.), University of Washington, Seattle
- Center for Cardiovascular Biology (P.M.B.), University of Washington, Seattle
| | - Jennifer Blackwood
- Emergency Medical Services Division, Public Health - Seattle & King County, Seattle, WA (J.B., T.D.R.)
| | - Thomas D Rea
- Department of Medicine (J.C., T.D.R.), University of Washington, Seattle
- Emergency Medical Services Division, Public Health - Seattle & King County, Seattle, WA (J.B., T.D.R.)
| | | |
Collapse
|
2
|
Driessen M, van der Plas-Duivesteijn S, Kienhuis AS, van den Brandhof EJ, Roodbergen M, van de Water B, Spaink HP, Palmblad M, van der Ven LTM, Pennings JLA. Identification of proteome markers for drug-induced liver injury in zebrafish embryos. Toxicology 2022; 477:153262. [PMID: 35868597 DOI: 10.1016/j.tox.2022.153262] [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: 05/19/2022] [Revised: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 10/17/2022]
Abstract
The zebrafish embryo (ZFE) is a promising alternative non-rodent model in toxicology, and initial studies suggested its applicability in detecting hepatic responses related to drug-induced liver injury (DILI). Here, we hypothesize that detailed analysis of underlying mechanisms of hepatotoxicity in ZFE contributes to the improved identification of hepatotoxic properties of compounds and to the reduction of rodents used for hepatotoxicity assessment. ZFEs were exposed to nine reference hepatotoxicants, targeted at induction of steatosis, cholestasis, and necrosis, and effects compared with negative controls. Protein profiles of the individual compounds were generated using LC-MS/MS. We identified differentially expressed proteins and pathways, but as these showed considerable overlap, phenotype-specific responses could not be distinguished. This led us to identify a set of common hepatotoxicity marker proteins. At the pathway level, these were mainly associated with cellular adaptive stress-responses, whereas single proteins could be linked to common hepatotoxicity-associated processes. Applying several stringency criteria to our proteomics data as well as information from other data sources resulted in a set of potential robust protein markers, notably Igf2bp1, Cox5ba, Ahnak, Itih3b.2, Psma6b, Srsf3a, Ces2b, Ces2a, Tdo2b, and Anxa1c, for the detection of adverse responses.
Collapse
Affiliation(s)
- Marja Driessen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, the Netherlands; Division of Drug Discovery and Safety, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC Leiden, the Netherlands
| | | | - Anne S Kienhuis
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, the Netherlands
| | - Evert-Jan van den Brandhof
- Centre for Environmental Quality, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, the Netherlands
| | - Marianne Roodbergen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, the Netherlands; Division of Drug Discovery and Safety, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC Leiden, the Netherlands
| | - Bob van de Water
- Division of Drug Discovery and Safety, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC Leiden, the Netherlands
| | - Herman P Spaink
- Institute of Biology, Leiden University, Einsteinweg 55, 2333 CC Leiden, the Netherlands
| | - Magnus Palmblad
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Leo T M van der Ven
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, the Netherlands
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, the Netherlands.
| |
Collapse
|
3
|
Pothineni NVK, Van Besien H, Fradley MG. Arrhythmic Complications Associated with Cancer Therapies. Heart Fail Clin 2022; 18:375-383. [PMID: 35718413 DOI: 10.1016/j.hfc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over the last several decades, advancements in cancer screening and treatment have significantly improved cancer mortality and overall quality of life. Unfortunately, non-cancer-related side effects, including cardiovascular toxicities can impact the continued delivery of these treatments. Arrhythmias are an increasingly recognized class of cardiotoxicity that can occur as a direct consequence of the treatment or secondary to another type of toxicity such as heart failure, myocarditis, or ischemia. Atrial arrhythmias, particularly atrial fibrillation (AF) are most commonly encountered, however, ventricular- and bradyarrhythmias can also occur, albeit at lower rates. Treatment strategies tailored to patients with cancer are essential to allow for the safe delivery of the cancer treatment without affecting short- or long-term oncologic or cardiovascular outcomes.
Collapse
Affiliation(s)
| | - Herman Van Besien
- Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael G Fradley
- Division of Cardiology, Department of Medicine, Cardio-Oncology Center of Excellence, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
4
|
Gopinathannair R, Pothineni NVK, Trivedi JR, Roukoz H, Cowger J, Ahmed MM, Bhan A, K. Ravichandran A, Bhat G, Al Ahmad A, Natale A, Di Biase L, Slaughter MS, Lakkireddy D. Amiodarone Use and All-Cause Mortality in Patients With a Continuous-Flow Left Ventricular Assist Device. J Am Heart Assoc 2022; 11:e023762. [PMID: 35656998 PMCID: PMC9238747 DOI: 10.1161/jaha.121.023762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality in ptients with a CF‐LVAD. Methods and Results A retrospective multicenter study of CF‐LVAD was conducted at 5 centers including all CF‐LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF‐LVAD implant amiodarone use. Additional use of amiodarone after CF‐LVAD implantation was also evaluated. Primary outcome was all‐cause mortality during long‐term follow‐up. Kaplan‐Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF‐LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF‐LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all‐cause mortality over the follow‐up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity‐matched group (log‐rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all‐cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). Conclusions Amiodarone use was associated with significantly increased rates of all‐cause mortality in CF‐LVAD recipients. Earlier interventions for arrhythmias to avoid long‐term amiodarone exposure may improve long‐term outcomes in CF‐LVAD recipients and needs further study.
Collapse
Affiliation(s)
| | | | - Jaimin R. Trivedi
- Department of Cardiothoracic SurgeryUniversity of LouisvilleLouisvilleKY
| | - Henri Roukoz
- Division of CardiologyUniversity of MinnesotaMinneapolisMN
| | | | | | - Adarsh Bhan
- Division of CardiologyAdvocate Christ Medical CenterOak LawnIL
| | | | - Geetha Bhat
- Division of CardiologyPennsylvania State UniversityHersheyPA
| | | | | | - Luigi Di Biase
- Division of CardiologyMontefiore Medical CenterNew YorkNY
| | - Mark S. Slaughter
- Department of Cardiothoracic SurgeryUniversity of LouisvilleLouisvilleKY
| | | |
Collapse
|
5
|
Valderrábano M. The Future of Antiarrhythmic Drug Therapy: Will Drugs Be Entirely Replaced by Procedures? Methodist Debakey Cardiovasc J 2022; 18:58-63. [PMID: 36561081 PMCID: PMC9733159 DOI: 10.14797/mdcvj.1185] [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: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Antiarrhythmic drug therapy has traditionally been centered in modulating the generation or propagation of the cardiac action potential by drugs acting on membrane ion channels. The history of this approach has been disappointing, marked by catastrophic failures such as those of sodium channel blockers or sotalol to treat ventricular arrhythmias in the setting of structural cardiomyopathies, which led to increased mortality, and by modest clinical efficacy in paroxysmal atrial fibrillation. As catheter ablation has become an established effective therapy for most tachyarrhythmias, membrane-acting drugs have been relegated to symptomatic control of benign arrhythmias in normal hearts or to adjunctive treatments of ventricular tachycardia (combined with catheter ablation and cardiac defibrillators) in the setting of cardiomyopathies. Novel targets of biological modulation of arrhythmia substrates beyond the membrane potential appear promising and could represent future opportunities for arrhythmia pharmacotherapy.
Collapse
Affiliation(s)
- Miguel Valderrábano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| |
Collapse
|
6
|
Porto R, Mengarda AC, Cajas RA, Salvadori MC, Teixeira FS, Arcanjo DDR, Siyadatpanah A, Pereira MDL, Wilairatana P, de Moraes J. Antiparasitic Properties of Cardiovascular Agents against Human Intravascular Parasite Schistosoma mansoni. Pharmaceuticals (Basel) 2021; 14:ph14070686. [PMID: 34358112 PMCID: PMC8308662 DOI: 10.3390/ph14070686] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/21/2023] Open
Abstract
The intravascular parasitic worm Schistosoma mansoni is a causative agent of schistosomiasis, a disease of great global public health significance. Praziquantel is the only drug available to treat schistosomiasis and there is an urgent demand for new anthelmintic agents. Adopting a phenotypic drug screening strategy, here, we evaluated the antiparasitic properties of 46 commercially available cardiovascular drugs against S. mansoni. From these screenings, we found that amiodarone, telmisartan, propafenone, methyldopa, and doxazosin affected the viability of schistosomes in vitro, with effective concentrations of 50% (EC50) and 90% (EC90) values ranging from 8 to 50 µM. These results were further supported by scanning electron microscopy analysis. Subsequently, the most effective drug (amiodarone) was further tested in a murine model of schistosomiasis for both early and chronic S. mansoni infections using a single oral dose of 400 mg/kg or 100 mg/kg daily for five consecutive days. Amiodarone had a low efficacy in chronic infection, with the worm and egg burden reduction ranging from 10 to 30%. In contrast, amiodarone caused a significant reduction in worm and egg burden in early infection (>50%). Comparatively, treatment with amiodarone is more effective in early infection than praziquantel, demonstrating the potential role of this cardiovascular drug as an antischistosomal agent.
Collapse
Affiliation(s)
- Raquel Porto
- Research Center for Neglected Diseases, Guarulhos University, Praça Tereza Cristina 229, São Paulo 07023-070, SP, Brazil; (R.P.); (A.C.M.); (R.A.C.)
| | - Ana C. Mengarda
- Research Center for Neglected Diseases, Guarulhos University, Praça Tereza Cristina 229, São Paulo 07023-070, SP, Brazil; (R.P.); (A.C.M.); (R.A.C.)
| | - Rayssa A. Cajas
- Research Center for Neglected Diseases, Guarulhos University, Praça Tereza Cristina 229, São Paulo 07023-070, SP, Brazil; (R.P.); (A.C.M.); (R.A.C.)
| | - Maria C. Salvadori
- Institute of Physics, University of São Paulo, São Paulo 05508-060, SP, Brazil; (M.C.S.); (F.S.T.)
| | - Fernanda S. Teixeira
- Institute of Physics, University of São Paulo, São Paulo 05508-060, SP, Brazil; (M.C.S.); (F.S.T.)
| | - Daniel D. R. Arcanjo
- Department of Biophysics and Physiology, Federal University of Piaui, Teresina 64049-550, PI, Brazil;
| | - Abolghasem Siyadatpanah
- Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand 9717853577, Iran;
| | - Maria de Lourdes Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Correspondence: (P.W.); (J.d.M.)
| | - Josué de Moraes
- Research Center for Neglected Diseases, Guarulhos University, Praça Tereza Cristina 229, São Paulo 07023-070, SP, Brazil; (R.P.); (A.C.M.); (R.A.C.)
- Correspondence: (P.W.); (J.d.M.)
| |
Collapse
|
7
|
Ibrahim Fouad G, R Mousa M. The protective potential of alpha lipoic acid on amiodarone-induced pulmonary fibrosis and hepatic injury in rats. Mol Cell Biochem 2021; 476:3433-3448. [PMID: 33973131 DOI: 10.1007/s11010-021-04173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022]
Abstract
Amiodarone (AMD) is a widely used antiarrhythmic drug prescribed to treat cardiac tachyarrhythmias; however, AMD has been reported to provoke pulmonary fibrosis (PF) and hepatotoxicity. This study aimed to investigate the influence of alpha lipoic acid (ALA) on AMD-induced PF and hepatotoxicity in male Wistar rats. AMD administration resulted in elevated lung contents of hydroxyproline (Hyp), malondialdehyde (MDA), and increased serum levels of transforming growth factor beta-1 (TGF-β1), interferon-γ (IFN-γ), alanine amino transaminase (ALT), aspartate amino transaminase (AST), total cholesterol (TC), and glucose. On the other side, lung content of glutathione reduced (GSH) and serum levels of total anti-oxidant capacity (TAC) were significantly decreased. Histopathologically, AMD caused PF, produced a mild hepatic injury, and increased expression of alpha smooth muscle actin (α-SMA). Treatment with ALA produced a significant reversal of the oxidative stress, fibrosis, and inflammation parameters with reductions in α-SMA expressions, leading to amelioration of histopathological lesions. ALA might provide supportive therapy in AMD-receiving cardiovascular patients.
Collapse
Affiliation(s)
- Ghadha Ibrahim Fouad
- Department of Therapeutic Chemistry, National Research Centre, 33 El-Bohouth St., Dokki, Cairo, 12622, Egypt.
| | - Mohamed R Mousa
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
| |
Collapse
|
8
|
Pharmacokinetic Disposition of Amiodarone When Given with an Intralipid Rescue Strategy. Pharmaceutics 2021; 13:pharmaceutics13040539. [PMID: 33924314 PMCID: PMC8069539 DOI: 10.3390/pharmaceutics13040539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
While the antiarrhythmic drug amiodarone is commonly used in clinical practice, it has a narrow therapeutic index that can lead to acute overdose. One proposed method to deal with this toxicity is lipid emulsion therapy, which may potentially quench the free amiodarone in blood and prevent its further distribution to target organs and tissues. In this study, we utilize an established swine model to examine the effects of Intralipid™ (IL) administration for acute amiodarone toxicity. A total of 14 pigs received an overdose of intravenous amiodarone. After twenty minutes, half of the pigs (n = 7) received IL while the control group (n = 7) received normal saline. Serum concentrations of amiodarone were then analyzed using a validated high-performance liquid chromatography (HPLC) method. Noncompartmental pharmacokinetic analyses were performed on the observed concentrations. There were no statistical differences in the area under the concentration time curve (6 h) or clearance, but there was a difference in the half-life between the two groups (3.12 vs. 0.85 h, p = 0.01). The administration of IL did not statistically change the overall exposure of amiodarone in the blood in the first 6 h; however, trends toward prolonged blood retention in the IL group were seen.
Collapse
|
9
|
Chakraborty P, Rose RA, Nair K, Downar E, Nanthakumar K. The rationale for repurposing funny current inhibition for management of ventricular arrhythmia. Heart Rhythm 2020; 18:130-137. [PMID: 32738405 DOI: 10.1016/j.hrthm.2020.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/14/2020] [Accepted: 07/25/2020] [Indexed: 11/26/2022]
Abstract
Management of ventricular arrhythmia in structural heart disease is complicated by the toxicity of the limited antiarrhythmic options available. In others, proarrhythmia and deleterious hemodynamic and noncardiac effects prevent practical use. This necessitates new thinking in therapeutic agents for ventricular arrhythmia in structural heart disease. Ivabradine, a funny current (If) inhibitor, has proven safety in heart failure, angina, and inappropriate sinus tachycardia. Although it is commonly known that funny channels are primarily expressed in the sinoatrial node, atrioventricular node, and conducting system of the ventricle, ivabradine is known to exert effects on metabolism, ion homeostasis, and membrane electrophysiology of remodeled ventricular myocardium. This review considers novel concepts and evidence from clinical and experimental studies regarding this paradigm, with a potential role of ivabradine in ventricular arrhythmia.
Collapse
Affiliation(s)
- Praloy Chakraborty
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Robert A Rose
- Libin Cardiovascular Institute of Alberta, An entity of the University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Krishnakumar Nair
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Eugene Downar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Yousif A, Ijaz S, Scherlag BJ. Intrapericardial administration of anti-arrhythmic medications in patients with electrical storm. Med Hypotheses 2020; 140:109640. [PMID: 32143072 DOI: 10.1016/j.mehy.2020.109640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electrical storm (ES) is cardiac electrical instability characterized by recurrent episodes of ventricular tachyarrhythmias. ES is associated with increased mortality and morbidity, hence requires prompt intervention. Treatment of underlying etiology is of prime importance in termination of ES. Anti-arrhythmic medications serve as an adjunctive therapy in suppression of ES by reducing myocardial excitability. The anti-arrhythmic conventionally employed is amiodarone in combination with non-selective beta-blockers to reduce the adrenergic input to myocardium. However, anti-arrhythmics at increased concentrations can lead to adverse systemic effects including hemodynamic instability. HYPOTHESIS We hypothesize 1. The use of intravenous or oral anti-arrhythmic therapy for patients in electrical storm is limited by their toxicities and blood pressure lowering effect. Corollary 1. Injection of anti-arrhythmic medications into the pericardial space, an extra-vascular structure encasing the heart, provides an option for use of higher concentration of anti-arrhythmic while limiting systemic absorption. Corollary 2. The pericardial space has direct communication to the epicardium, the outer most layer of cardiac muscle, spatial proximity may allow for effective therapeutic options in electrical storm. We present experimental and clinical evidence in support of these hypothesis.
Collapse
Affiliation(s)
- Ali Yousif
- Heart Rhythm Institute, University of Oklahoma Health Science Center, United States
| | - Sardar Ijaz
- Department of Internal Medicine, University of Oklahoma Health Science Center, United States
| | - Benjamin J Scherlag
- Heart Rhythm Institute, University of Oklahoma Health Science Center, United States.
| |
Collapse
|
11
|
Oragano CA, Patton D, Moore Z. Phlebitis in Intravenous Amiodarone Administration: Incidence and Contributing Factors. Crit Care Nurse 2019; 39:e1-e12. [PMID: 30710042 DOI: 10.4037/ccn2019381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect. OBJECTIVES To determine the incidence and contributing factors of amiodarone-induced phlebitis and examine phlebitis severity. METHODS A systematic review was conducted of articles published before February 2016 in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, MEDLINE, Embase, Web of Science, and gray databases (Bielefeld, Lenus, EUGrey, RIAN, and DART). All studies in which amiodarone-induced phlebitis was a primary or secondary outcome were included. Meta-analysis was not appropriate because of study heterogeneity. Studies of the same contributing factors were analyzed together. RESULTS In the 20 included studies, phlebitis incidence ranged from 0% to 85%. Increasing the infusion concentration from 1.2 mg/mL to 1.8 mg/mL increased the phlebitis rate (P < .001). Total amiodarone doses greater than 1 g resulted in higher phlebitis rates than did doses less than 0.45 mg (P < .001). Most infusion durations and rates were not correlated with phlebitis incidence. However, phlebitis incidence was lower with bolus administration than with longer infusions (P = .002). The use of in-line filters and nursing guidelines significantly reduced phlebitis rates (P < .001) and phlebitis severity. The most common phlebitis severity grades, in descending order, were 0, 1, 2, 3, and 4. CONCLUSIONS Understanding factors that increase the risk of amiodarone-induced phlebitis can guide better practice. In-line filters and nursing guidelines should always be implemented when administering intravenous amiodarone. Increased surveillance is required when higher dosages and concentrations are used.
Collapse
Affiliation(s)
- Carol Ann Oragano
- Carol Ann Oragano is a cardiac nurse specialist in Urgent Cardiac Care, Mater Private, Dublin, Ireland. .,Declan Patton is a senior lecturer and director of nursing and midwifery research, School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland. .,Zena Moore is professor and head of the School of Nursing and Midwifery, Royal College of Surgeons in Ireland.
| | - Declan Patton
- Carol Ann Oragano is a cardiac nurse specialist in Urgent Cardiac Care, Mater Private, Dublin, Ireland.,Declan Patton is a senior lecturer and director of nursing and midwifery research, School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Zena Moore is professor and head of the School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Zena Moore
- Carol Ann Oragano is a cardiac nurse specialist in Urgent Cardiac Care, Mater Private, Dublin, Ireland.,Declan Patton is a senior lecturer and director of nursing and midwifery research, School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Zena Moore is professor and head of the School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| |
Collapse
|
12
|
Parkash R, Nault I, Rivard L, Gula L, Essebag V, Nery P, Tung S, Raymond JM, Sterns L, Doucette S, Wells G, Tang ASL, Stevenson WG, Sapp JL. Effect of Baseline Antiarrhythmic Drug on Outcomes With Ablation in Ischemic Ventricular Tachycardia: A VANISH Substudy (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease). Circ Arrhythm Electrophysiol 2019; 11:e005663. [PMID: 29305400 DOI: 10.1161/circep.117.005663] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) compared the effectiveness of escalated antiarrhythmic drug therapy to catheter ablation in patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia (VT). The effectiveness of these interventions in patients on sotalol versus amiodarone was compared. METHODS AND RESULTS Analysis was conducted based on whether patients had recurrent VT, despite amiodarone (amio-refractory) or nonamiodarone drugs (sotalol-refractory). Outcomes included death, VT storm, appropriate implantable cardioverter defibrillator shock, and any ventricular arrhythmia. At baseline, 169 (65.2%) were amio-refractory, and 90 (34.7%) were sotalol-refractory (1 patient on procainamide rather than sotalol). Amio-refractory patients had more renal insufficiency (23.7% versus 10%; P=0.0008), worse New York Heart Association class (82.3% II/III versus 65.5%; P=0.0003), and lower ejection fraction (29±9.7% versus 35.2±11%; P<0.0001). Within the amio-refractory group, ablation resulted in reduction of any ventricular arrhythmia compared with escalated drug therapy (hazard ratio, 0.53; 95% confidence interval, 0.31-0.9), P=0.020). Sotalol-refractory patients had trends toward higher mortality and VT storm with ablation, with no effect on implantable cardioverter defibrillator shocks. Within the escalated drug therapy arm, amio-refractory patients had a higher rate of the composite outcome (hazard ratio, 1.94; 95% confidence interval, 1.14-3.29; P=0.0144) and a trend to higher mortality (hazard ratio, 2.40; 95% confidence interval, 0.93-6.22; P=0.07), whereas mortality was not different between amio- and sotalol-refractory patients within the ablation treatment group. CONCLUSIONS Patients with amio-refractory VT have a higher rate of ventricular arrhythmia and mortality than those with sotalol-refractory VT and derive greater benefit of catheter ablation than for patients with sotalol-refractory VT who are switched to amiodarone. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT00905853.
Collapse
Affiliation(s)
- Ratika Parkash
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - Isabelle Nault
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Lena Rivard
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Lorne Gula
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Vidal Essebag
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Pablo Nery
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Stanley Tung
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Jean-Marc Raymond
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Laurence Sterns
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Steve Doucette
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - George Wells
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Anthony S L Tang
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - William G Stevenson
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - John L Sapp
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| |
Collapse
|
13
|
Santangeli P, Tung R, Xue Y, Chung FP, Lin YJ, Di Biase L, Zhan X, Lin CY, Wei W, Mohanty S, Burkhardt DJ, Zado ES, Callans DJ, Marchlinski FE, Wu S, Chen SA, Natale A. Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy. JACC Clin Electrophysiol 2019; 5:55-65. [DOI: 10.1016/j.jacep.2018.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 10/27/2022]
|
14
|
LC-MS Method for Determining Amiodarone and Desethylaminodarone in Rat Plasma Used in Endogenous Overdosing Conditions Following Lipolysis. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: The purpose of this study was to develop a LC-MS method to determine amiodarone (AMI) and its major metabolite desethylamiodarone (DEA) from rat plasma released from the adipose tissue of AMI treated rats subjected to a weight gain/weight loss cycle. Methods: Separation of the compounds was performed on a Kinetex 2.6 μm C18 100 x 4.6 mm column under isocratic conditions using a mixture of acetonitrile: 0.1% formic acid 65:35 at a flow rate of 0.5 ml/min. Detection of the analyte was performed by electrospray positive ionization, the monitored ions being 135 m/z from 646 for AMI and 135 m/z of 618 for DEA. Analytes were extracted after plasma protein precipitation with methanol. Results: The developed method presented specificity and linearity on the concentration range of 25-2500 ng/ml plasma for AMI and 2.5-1250 ng/ml plasma for DEA and the precision and accuracy of the method at all of quality control concentration levels including LLOQ were according to official guidelines for validating analytical methods. Conclusions: A sensitive and accurate LC-MS method has been developed with a much lower LLOQ than literature data to detect the plasma concentration differences of the studied analytes that result from forced lipolysis and mobilization from the adipose tissue.
Collapse
|
15
|
Al-Gobari M, Al-Aqeel S, Gueyffier F, Burnand B. Effectiveness of drug interventions to prevent sudden cardiac death in patients with heart failure and reduced ejection fraction: an overview of systematic reviews. BMJ Open 2018; 8:e021108. [PMID: 30056380 PMCID: PMC6067373 DOI: 10.1136/bmjopen-2017-021108] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To summarise and synthesise the current evidence regarding the effectiveness of drug interventions to prevent sudden cardiac death (SCD) and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). DESIGN Overview of systematic reviews. DATA SOURCES MEDLINE, Embase, ISI Web of Science and Cochrane Library from inception to May 2017; manual search of references of included studies for potentially relevant reviews. ELIGIBILITY CRITERIA FOR STUDY SELECTION We reviewed the effectiveness of drug interventions for SCD and all-cause mortality prevention in patients with HFrEF. We included overviews, systematic reviews and meta-analyses of randomised controlled trials of beta-blockers, angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARBs), antialdosterones or mineralocorticoid-receptor antagonists, amiodarone, other antiarrhythmic drugs, combined ARB/neprilysin inhibitors, statins and fish oil supplementation. REVIEW METHODS Two independent reviewers extracted data and assessed the methodological quality of the reviews and the quality of evidence for the primary studies for each drug intervention, using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) and Grading of Recommendations, Assessment, Development and Evaluation(GRADE), respectively. RESULTS We identified 41 reviews. Beta-blockers, antialdosterones and combined ARB/neprilysin inhibitors appeared effective to prevent SCD and all-cause mortality. ACE-i significantly reduced all-cause mortality but not SCD events. ARBs and statins were ineffective where antiarrhythmic drugs and omega-3 fatty acids had unclear evidence of effectiveness for prevention of SCD and all-cause mortality. CONCLUSIONS This comprehensive overview of systematic reviews confirms that beta-blockers, antialdosterone agents and combined ARB/neprilysin inhibitors are effective on SCD prevention but not ACE-i or ARBs. In patients with high risk of SCD, an alternative therapeutic strategy should be explored in future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017067442.
Collapse
Affiliation(s)
- Muaamar Al-Gobari
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive-Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
16
|
van Bavel JJA, Vos MA, van der Heyden MAG. Cardiac Arrhythmias and Antiarrhythmic Drugs: An Autophagic Perspective. Front Physiol 2018. [PMID: 29527175 PMCID: PMC5829447 DOI: 10.3389/fphys.2018.00127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Degradation of cellular material by lysosomes is known as autophagy, and its main function is to maintain cellular homeostasis for growth, proliferation and survival of the cell. In recent years, research has focused on the characterization of autophagy pathways. Targeting of autophagy mediators has been described predominantly in cancer treatment, but also in neurological and cardiovascular diseases. Although the number of studies is still limited, there are indications that activity of autophagy pathways increases under arrhythmic conditions. Moreover, an increasing number of antiarrhythmic and non-cardiac drugs are found to affect autophagy pathways. We, therefore, suggest that future work should recognize the largely unaddressed effects of antiarrhythmic agents and other classes of drugs on autophagy pathway activation and inhibition.
Collapse
Affiliation(s)
- Joanne J A van Bavel
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
17
|
Juhász V, Hornyik T, Benák A, Nagy N, Husti Z, Pap R, Sághy L, Virág L, Varró A, Baczkó I. Comparison of the effects of I K,ACh, I Kr, and I Na block in conscious dogs with atrial fibrillation and on action potentials in remodeled atrial trabeculae. Can J Physiol Pharmacol 2017; 96:18-25. [PMID: 28892643 DOI: 10.1139/cjpp-2017-0342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of morbidity and mortality. Traditional antiarrhythmic agents used for restoration of sinus rhythm have limited efficacy in long-term AF and they may possess ventricular proarrhythmic adverse effects, especially in patients with structural heart disease. The acetylcholine receptor-activated potassium channel (IK,ACh) represents an atrial selective target for future AF management. We investigated the effects of the IK,ACh blocker tertiapin-Q (TQ), a derivative of the honeybee toxin tertiapin, on chronic atrial tachypacing-induced AF in conscious dogs, without the influence of anesthetics that modulate a number of cardiac ion channels. Action potentials (APs) were recorded from right atrial trabeculae isolated from dogs with AF. TQ significantly and dose-dependently reduced AF incidence and AF episode duration, prolonged atrial effective refractory period, and prolonged AP duration. The reference drugs propafenone and dofetilide, both used in the clinical management of AF, exerted similar effects against AF in vivo. Dofetilide prolonged atrial AP duration, whereas propafenone increased atrial conduction time. TQ and propafenone did not affect the QT interval, whereas dofetilide prolonged the QT interval. Our results show that inhibition of IK,ACh may represent a novel, atrial-specific target for the management of AF in chronic AF.
Collapse
Affiliation(s)
- Viktor Juhász
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Tibor Hornyik
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Attila Benák
- b 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Norbert Nagy
- c MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Zoltán Husti
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Róbert Pap
- b 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- b 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Virág
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - András Varró
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,c MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - István Baczkó
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| |
Collapse
|
18
|
Muser D, Santangeli P, Castro SA, Pathak RK, Liang JJ, Hayashi T, Magnani S, Garcia FC, Hutchinson MD, Supple GG, Frankel DS, Riley MP, Lin D, Schaller RD, Dixit S, Zado ES, Callans DJ, Marchlinski FE. Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004328. [PMID: 27733494 DOI: 10.1161/circep.116.004328] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy. METHODS AND RESULTS We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT. Adjuvant epicardial ablation was performed for recurrent VT or persistent inducibility after endocardial-only ablation. Epicardial ablation was performed in 90 (32%) patients. Before ablation, patients failed a median of 2 antiarrhythmic drugs), including amiodarone, in 166 (59%) patients. The median follow-up after the last procedure was 48 (19-67) months. Overall, VT-free survival was 69% at 60-month follow-up. Transplant-free survival was 76% and 68% at 60- and 120-month follow-up, respectively. Among the 58 (21%) patients with VT recurrence, CA still resulted in a significant reduction of VT burden, with 31 (53%) patients having only isolated (1-3) VT episodes in 12 (4-35) months after the procedure. At the last follow-up, 128 (45%) patients were only on β-blockers or no treatment, 41 (15%) were on sotalol or class I antiarrhythmic drugs, and 62 (22%) were on amiodarone. CONCLUSIONS In patients with nonischemic dilated cardiomyopathy and VT, endocardial and adjuvant epicardial CA is effective in achieving long-term VT freedom in 69% of cases, with a substantial improvement in VT burden in many of the remaining patients.
Collapse
Affiliation(s)
- Daniele Muser
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Pasquale Santangeli
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Simon A Castro
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Rajeev K Pathak
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Jackson J Liang
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Tatsuya Hayashi
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Silvia Magnani
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Fermin C Garcia
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Mathew D Hutchinson
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Gregory G Supple
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - David S Frankel
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael P Riley
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - David Lin
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D Schaller
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Sanjay Dixit
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Erica S Zado
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - David J Callans
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
| |
Collapse
|
19
|
Abstract
Implantable cardioverter defibrillators (ICDs) reduce the mortality risk associated with recurrent ventricular tachycardia (VT) and can frequently terminate VT episodes painlessly, but do not prevent recurrent episodes. For patients with symptomatic recurrences, frequent asymptomatic recurrences, ICD shocks, or VT storm, most clinicians recommend strategies to suppress VT. The proarrhythmic mortality risk of antiarrhythmic drugs (AADs) may be mitigated by the presence of an ICD, but these medications are limited by high recurrence rates, and unfavorable side effect profiles. Catheter ablation is an alternative or adjunctive option, but is also limited by incomplete efficacy and procedural risk.
Collapse
Affiliation(s)
- Ciorsti J MacIntyre
- Dalhousie University, QEII Health Sciences Centre, Room 2501 F Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7
| | - John L Sapp
- Dalhousie University, QEII Health Sciences Centre, Room 2501 F Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7.
| |
Collapse
|
20
|
Ji Y, Takanari H, Qile M, Nalos L, Houtman MJC, Romunde FL, Heukers R, van Bergen En Henegouwen PMP, Vos MA, van der Heyden MAG. Class III antiarrhythmic drugs amiodarone and dronedarone impair K IR 2.1 backward trafficking. J Cell Mol Med 2017; 21:2514-2523. [PMID: 28425222 PMCID: PMC5618701 DOI: 10.1111/jcmm.13172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/24/2017] [Indexed: 01/16/2023] Open
Abstract
Drug‐induced ion channel trafficking disturbance can cause cardiac arrhythmias. The subcellular level at which drugs interfere in trafficking pathways is largely unknown. KIR2.1 inward rectifier channels, largely responsible for the cardiac inward rectifier current (IK1), are degraded in lysosomes. Amiodarone and dronedarone are class III antiarrhythmics. Chronic use of amiodarone, and to a lesser extent dronedarone, causes serious adverse effects to several organs and tissue types, including the heart. Both drugs have been described to interfere in the late‐endosome/lysosome system. Here we defined the potential interference in KIR2.1 backward trafficking by amiodarone and dronedarone. Both drugs inhibited IK1 in isolated rabbit ventricular cardiomyocytes at supraclinical doses only. In HK‐KWGF cells, both drugs dose‐ and time‐dependently increased KIR2.1 expression (2.0 ± 0.2‐fold with amiodarone: 10 μM, 24 hrs; 2.3 ± 0.3‐fold with dronedarone: 5 μM, 24 hrs) and late‐endosomal/lysosomal KIR2.1 accumulation. Increased KIR2.1 expression level was also observed in the presence of Nav1.5 co‐expression. Augmented KIR2.1 protein levels and intracellular accumulation were also observed in COS‐7, END‐2, MES‐1 and EPI‐7 cells. Both drugs had no effect on Kv11.1 ion channel protein expression levels. Finally, amiodarone (73.3 ± 10.3% P < 0.05 at −120 mV, 5 μM) enhanced IKIR2.1 upon 24‐hrs treatment, whereas dronedarone tended to increase IKIR2.1 and it did not reach significance (43.8 ± 5.5%, P = 0.26 at −120 mV; 2 μM). We conclude that chronic amiodarone, and potentially also dronedarone, treatment can result in enhanced IK1 by inhibiting KIR2.1 degradation.
Collapse
Affiliation(s)
- Yuan Ji
- Division of Heart & Lungs, Department of Medical Physiology, UMCU, Utrecht, The Netherlands
| | - Hiroki Takanari
- Division of Heart & Lungs, Department of Medical Physiology, UMCU, Utrecht, The Netherlands
| | - Muge Qile
- Division of Heart & Lungs, Department of Medical Physiology, UMCU, Utrecht, The Netherlands
| | - Lukas Nalos
- Department of Physiology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Marien J C Houtman
- Division of Heart & Lungs, Department of Medical Physiology, UMCU, Utrecht, The Netherlands
| | - Fee L Romunde
- Division of Heart & Lungs, Department of Medical Physiology, UMCU, Utrecht, The Netherlands
| | - Raimond Heukers
- Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht, The Netherlands
| | | | - Marc A Vos
- Division of Heart & Lungs, Department of Medical Physiology, UMCU, Utrecht, The Netherlands
| | | |
Collapse
|
21
|
Santangeli P, Rame JE, Birati EY, Marchlinski FE. Management of Ventricular Arrhythmias in Patients With Advanced Heart Failure. J Am Coll Cardiol 2017; 69:1842-1860. [DOI: 10.1016/j.jacc.2017.01.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 02/08/2023]
|
22
|
Karlis G, Iacovidou N, Lelovas P, Niforopoulou P, Papalois A, Siafaka I, Mentzelopoulos S, Xanthos T. Nifekalant Versus Amiodarone in the Treatment of Cardiac Arrest: an Experimental Study in a Swine Model of Prolonged Ventricular Fibrillation. Cardiovasc Drugs Ther 2016; 29:425-31. [PMID: 26145169 DOI: 10.1007/s10557-015-6604-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the experiment was to compare the effects of nifekalant and amiodarone on the return of spontaneous circulation (ROSC), survival, as well as on the hemodynamic parameters in a swine model of prolonged ventricular fibrillation (VF). METHODS After 8 min of untreated VF, bolus doses of epinephrine (adrenaline) and either nifekalant, or amiodarone, or saline (n = 10 per group), were administered after randomization. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration and defibrillation was attempted 2 min later. CPR was resumed for another 2 min after each defibrillation attempt and the same dose of adrenaline was given every 4th minute during CPR. RESULTS Forty-eight hour survival was significantly higher with nifekalant compared to amiodarone (p < 0.001) and saline (p = 0.02), (9/10 vs. 0/10 vs. 3/10, respectively). Systolic aortic pressure, diastolic aortic pressure and coronary perfusion pressure were significantly higher with nifekalant during CPR and immediate post-resuscitation period (p < 0.05). The animals in the amiodarone group had a slower heart rate at the 1st and 45th min post-ROSC (p < 0.001 and p = 0.006, respectively). The number of electric shocks required for terminating VF, time to ROSC and adrenaline dose were significantly higher with amiodarone compared to nifekalant (p < 0.001). CONCLUSIONS Nifekalant showed a more favorable hemodynamic profile and improved survival compared to amiodarone and saline in this swine model.
Collapse
Affiliation(s)
- George Karlis
- 2nd Department of Internal Medicine, Sismanoglio General Hospital, Athens, Greece. .,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,2nd Department of Obstetrics and Gynecology, Neonatal Division, Aretaieio Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Pavlos Lelovas
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | | | - Ioanna Siafaka
- 1st Anesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Spyros Mentzelopoulos
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,MSc "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Midwestern University of Chicago, Chicago, IL, USA
| |
Collapse
|
23
|
Diederichsen SZ, Darkner S, Chen X, Johannesen A, Pehrson S, Hansen J, Feldt-Rasmussen U, Svendsen JH. Short-term amiodarone treatment for atrial fibrillation after catheter ablation induces a transient thyroid dysfunction: Results from the placebo-controlled, randomized AMIO-CAT trial. Eur J Intern Med 2016; 33:36-41. [PMID: 27129624 DOI: 10.1016/j.ejim.2016.04.012] [Citation(s) in RCA: 8] [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: 01/24/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Amiodarone is known to affect the thyroid, but little is known about thyroid recovery after short-term amiodarone treatment. OBJECTIVES We aimed to evaluate the impact of 8weeks of amiodarone treatment on thyroid function in patients with atrial fibrillation (AF) undergoing catheter ablation in a randomised, double-blind clinical trial. METHODS 212 patients referred for AF ablation at two centres were randomized to 8weeks of oral amiodarone or placebo. Thyroid function tests (TSH, thyroid stimulating hormone; T4, thyroxine; T3, triiodothyronine; fT4, free T4; fT3, free T3) were performed at baseline and 1, 3 and 6months. RESULTS Study drug was discontinued due to mild thyroid dysfunction in 1 patient in the placebo vs. 3 in the amiodarone group (p=0.6). In linear mixed models there were significant effects of amiodarone on thyroid function tests, modified by follow-up visit (p<10(-9) for both TSH, T4, T3, fT4 and fT3). The amiodarone group had higher TSH, fT4 and T4 after 1 and 3months compared to placebo, whereas T3 and fT3 were lower. In all cases, the amiodarone-induced thyroid dysfunction was largest at 1month, declining at 3months, and with no differences at 6months, compared to baseline. CONCLUSION We found amiodarone to have a significant impact on thyroid function after only 1month, but with a fast recovery of thyroid function after amiodarone discontinuation. Our study indicates that short-term amiodarone can be considered safe in patients without prior thyroid dysfunction.
Collapse
Affiliation(s)
- Søren Zöga Diederichsen
- Department of Cardiology, Section 2013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Stine Darkner
- Department of Cardiology, Section 2013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Xu Chen
- Department of Cardiology, Section 2013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Arne Johannesen
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Gentofte, Denmark
| | - Steen Pehrson
- Department of Cardiology, Section 2013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jim Hansen
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Gentofte, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Section 2132, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Section 2013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; The Danish National Research Centre for Cardiac Arrhythmia, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
24
|
Foufelle F, Fromenty B. Role of endoplasmic reticulum stress in drug-induced toxicity. Pharmacol Res Perspect 2016; 4:e00211. [PMID: 26977301 PMCID: PMC4777263 DOI: 10.1002/prp2.211] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022] Open
Abstract
Drug‐induced toxicity is a key issue for public health because some side effects can be severe and life‐threatening. These adverse effects can also be a major concern for the pharmaceutical companies since significant toxicity can lead to the interruption of clinical trials, or the withdrawal of the incriminated drugs from the market. Recent studies suggested that endoplasmic reticulum (ER) stress could be an important event involved in drug liability, in addition to other key mechanisms such as mitochondrial dysfunction and oxidative stress. Indeed, drug‐induced ER stress could lead to several deleterious effects within cells and tissues including accumulation of lipids, cell death, cytolysis, and inflammation. After recalling important information regarding drug‐induced adverse reactions and ER stress in diverse pathophysiological situations, this review summarizes the main data pertaining to drug‐induced ER stress and its potential involvement in different adverse effects. Drugs presented in this review are for instance acetaminophen (APAP), arsenic trioxide and other anticancer drugs, diclofenac, and different antiretroviral compounds. We also included data on tunicamycin (an antibiotic not used in human medicine because of its toxicity) and thapsigargin (a toxic compound of the Mediterranean plant Thapsia garganica) since both molecules are commonly used as prototypical toxins to induce ER stress in cellular and animal models.
Collapse
|
25
|
Long-Term Outcome With Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:1413-21. [DOI: 10.1161/circep.115.003562] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
|
26
|
Xuan J, Chen S, Ning B, Tolleson WH, Guo L. Development of HepG2-derived cells expressing cytochrome P450s for assessing metabolism-associated drug-induced liver toxicity. Chem Biol Interact 2015; 255:63-73. [PMID: 26477383 DOI: 10.1016/j.cbi.2015.10.009] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/30/2015] [Accepted: 10/09/2015] [Indexed: 01/08/2023]
Abstract
The generation of reactive metabolites from therapeutic agents is one of the major mechanisms of drug-induced liver injury (DILI). In order to evaluate metabolism-related toxicity and improve drug efficacy and safety, we generated a battery of HepG2-derived cell lines that express 14 cytochrome P450s (CYPs) (1A1, 1A2, 1B1, 2A6, 2B6, 2C8, 2C9, 2C18, 2C19, 2D6, 2E1, 3A4, 3A5 and 3A7) individually using a lentiviral expression system. The expression/production of a specific CYP in each cell line was confirmed by an increased abundance of the CYP at both mRNA and protein levels. Moreover, the enzymatic activities of representative CYPs in the corresponding cell lines were also measured. Using our CYP-expressed HepG2 cells, the toxicity of three drugs that could induce DILI (amiodarone, chlorpromazine and primaquine) was assessed, and all of them showed altered (increased or decreased) toxicity compared to the toxicity in drug-treated wild-type HepG2 cells. CYP-mediated drug toxicity examined in our cell system is consistent with previous reports, demonstrating the potential of these cells for assessing metabolism-related drug toxicity. This cell system provides a practical in vitro approach for drug metabolism screening and for early detection of drug toxicity. It is also a surrogate enzyme source for the enzymatic characterization of a particular CYP that contributes to drug-induced liver toxicity.
Collapse
Affiliation(s)
- Jiekun Xuan
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Si Chen
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Baitang Ning
- Division of System Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - William H Tolleson
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Lei Guo
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| |
Collapse
|
27
|
Barbara DW, Rehfeldt KH, Pulido JN, Li Z, White RD, Schaff HV, Mauermann WJ. Diastolic function and new-onset atrial fibrillation following cardiac surgery. Ann Card Anaesth 2015; 18:8-14. [PMID: 25566703 PMCID: PMC4900315 DOI: 10.4103/0971-9784.148313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Numerous studies have reported predictors of new-onset postoperative atrial fibrillation (POAF) following cardiac surgery, which is associated with increased length of stay, cost of care, morbidity, and mortality. The purpose of this study was to examine the association between preoperative diastolic function and occurrence of new-onset POAF in patients undergoing a variety of cardiac surgeries at a single institution. Methods: Using data from a prospective study from November 2007 to January 2010, a retrospective review was conducted. The diastolic function of each patient was determined from preoperative transthoracic echocardiograms. Occurrence of new-onset POAF was prospectively noted for each patient in the original study. Demographic and operative characteristics of the study population were analyzed to determine predictors of POAF. Results: Of 223 patients, 91 (40.8%) experienced new-onset POAF. Univariate predictors of POAF included increasing age, male gender, operations involving mitral valve repair/replacement, nonsmoking, hypertension, increased intraoperative pulmonary artery pressure, grade I diastolic dysfunction, abnormal diastolic function of any grade, decreased medial e’, elevated medial E/e’, and increased left atrial volume. Multivariate predictors of POAF included increasing age, increased left atrial volume, and elevated initial intraoperative pulmonary artery pressure. Even after exclusion of patients with hypertrophic obstructive cardiomyopathy or those undergoing mitral valve operations, diastolic dysfunction was not a multivariate predictor of POAF. Conclusions: In the patient population studied here, preoperative diastolic dysfunction was not predictive of POAF. In addition to increasing age, initial intraoperative pulmonary artery systolic pressure and left atrial volume were both significant multivariate predictors of POAF.
Collapse
Affiliation(s)
| | | | | | | | | | | | - William J Mauermann
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
28
|
Bardai A, Blom MT, van Hoeijen DA, van Deutekom HW, Brouwer HJ, Tan HL. Atrial Fibrillation Is an Independent Risk Factor for Ventricular Fibrillation. Circ Arrhythm Electrophysiol 2014; 7:1033-9. [DOI: 10.1161/circep.114.002094] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abdennasser Bardai
- From the Heart Center, Department of Cardiology (A.B., M.T.B., D.A.v.H., H.W.M.v.D., H.L.T.), and Department of General Practice (H.J.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T. Blom
- From the Heart Center, Department of Cardiology (A.B., M.T.B., D.A.v.H., H.W.M.v.D., H.L.T.), and Department of General Practice (H.J.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel A. van Hoeijen
- From the Heart Center, Department of Cardiology (A.B., M.T.B., D.A.v.H., H.W.M.v.D., H.L.T.), and Department of General Practice (H.J.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W.M. van Deutekom
- From the Heart Center, Department of Cardiology (A.B., M.T.B., D.A.v.H., H.W.M.v.D., H.L.T.), and Department of General Practice (H.J.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk J. Brouwer
- From the Heart Center, Department of Cardiology (A.B., M.T.B., D.A.v.H., H.W.M.v.D., H.L.T.), and Department of General Practice (H.J.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L. Tan
- From the Heart Center, Department of Cardiology (A.B., M.T.B., D.A.v.H., H.W.M.v.D., H.L.T.), and Department of General Practice (H.J.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
29
|
A transcriptomics-based hepatotoxicity comparison between the zebrafish embryo and established human and rodent in vitro and in vivo models using cyclosporine A, amiodarone and acetaminophen. Toxicol Lett 2014; 232:403-12. [PMID: 25448281 DOI: 10.1016/j.toxlet.2014.11.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022]
Abstract
The zebrafish embryo (ZFE) is a promising alternative, non-rodent model in toxicology, which has an advantage over the traditionally used models as it contains complete biological complexity and provides a medium to high-throughput setting. Here, we assess how the ZFE compares to the traditionally used models for liver toxicity testing, i.e., in vivo mouse and rat liver, in vitro mouse and rat hepatocytes, and primary human hepatocytes. For this comparison, we analyzed gene expression changes induced by three model compounds for cholestasis, steatosis, and necrosis. The three compounds, cyclosporine A, amiodarone, and acetaminophen, were chosen because of their relevance to human toxicity and these compounds displayed hepatotoxic-specific changes in the mouse in vivo data. Compound induced expression changes in the ZFE model shared similarity with both in vivo and in vitro. Comparison on single gene level revealed the presence of model specific changes and no clear concordance across models. However, concordance was identified on the pathway level. Specifically, the pathway "regulation of metabolism - bile acids regulation of glucose and lipid metabolism via FXR" was affected across all models and compounds. In conclusion, our study with three hepatotoxic model compounds shows that the ZFE model is at least as comparable to traditional models in identifying hepatotoxic activity and has the potential for use as a pre-screen to determine the hepatotoxic potential of compounds.
Collapse
|
30
|
Kim HL, Seo JB, Chung WY, Kim SH, Kim MA, Zo JH. The incidence and predictors of overall adverse effects caused by low dose amiodarone in real-world clinical practice. Korean J Intern Med 2014; 29:588-96. [PMID: 25228834 PMCID: PMC4164722 DOI: 10.3904/kjim.2014.29.5.588] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/03/2013] [Accepted: 04/07/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Most current knowledge regarding amiodarone toxicity derives from clinical trials. This study was performed to investigate the incidence and risk factors of overall adverse effects of amiodarone in real-world practice using a large sample size. METHODS Between January 1, 2000 and March 10, 2012, a total of 930 consecutive patients who had been treated with amiodarone for arrhythmia were reviewed retrospectively. An amiodarone-associated adverse event was considered in cases of discontinuation or drug dose reduction due to an unexpected clinical response. RESULTS The mean daily dose of amiodarone was 227 ± 126 mg, and the mean duration was 490 ± 812 days. During the mean follow-up duration of 982 ± 1,137 days, a total of 154 patients (16.6%) experienced adverse effects related to amiodarone, the most common being bradycardia or conduction disturbance (9.5%). Major organ toxicities in the thyroid (2.5%), liver (2.2%), eyes (0.6%), and lungs (0.3%) were rare. All patients recovered fully without complications after amiodarone discontinuation or dose reduction. The only independent predictor of adverse effects was the duration of amiodarone treatment (odds ratio, 1.21; 95% confidence interval, 1.03 to 1.41; p = 0.016, per year). CONCLUSIONS Low-dose amiodarone is well tolerated in a real-world clinical population. Further studies with a prospective design are needed to confirm this finding.
Collapse
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Young Chung
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
31
|
Driessen M, Kienhuis AS, Vitins AP, Pennings JLA, Pronk TE, van den Brandhof EJ, Roodbergen M, van de Water B, van der Ven LTM. Gene expression markers in the zebrafish embryo reflect a hepatotoxic response in animal models and humans. Toxicol Lett 2014; 230:48-56. [PMID: 25064622 DOI: 10.1016/j.toxlet.2014.06.844] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/03/2014] [Accepted: 06/27/2014] [Indexed: 02/04/2023]
Abstract
The zebrafish embryo (ZFE) is a promising non-rodent model in toxicology, and initial studies suggested its applicability in detecting hepatotoxic responses. Here, we hypothesize that the detailed analysis of underlying mechanisms of hepatotoxicity in ZFE contributes to the improved identification of hepatotoxic properties of new compounds and to the reduction of rodents used for screening. ZFEs were exposed to nine reference hepatotoxicants, targeted at induction of cholestasis, steatosis and necrosis, and two non-hepatotoxic controls. Histopathology revealed various specific morphological changes in the ZFE hepatocytes indicative of cell injury. Gene expression profiles of the individual compounds were generated using microarrays. Regulation of single genes and of pathways could be linked to hepatotoxic responses in general, but phenotype-specific responses could not be distinguished. Hepatotoxicity-associated pathways included xenobiotic metabolism and oxidoreduction related pathways. Overall analysis of gene expression identified a limited set of potential biomarkers specific for a common hepatotoxicity response. This set included several cytochrome P450 genes (cyp2k19, cyp4v7, cyp2aa3), genes related to liver development (pklr) and genes important in oxidoreduction processes (zgc:163022, zgc:158614, zgc:101858 and sqrdl). In conclusion, the ZFE model allows for identification of hepatotoxicants, without discrimination into specific phenotypes.
Collapse
Affiliation(s)
- Marja Driessen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Division of Toxicology, Leiden/Amsterdam Centre for Drug Research, Leiden University, Einsteinweg 55, 2333CC Leiden, The Netherlands
| | - Anne S Kienhuis
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Alexa P Vitins
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Department of Toxicogenomics, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Tessa E Pronk
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Department of Toxicogenomics, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Evert-Jan van den Brandhof
- Centre for Environmental Quality, National Institute for Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, The Netherlands
| | - Marianne Roodbergen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Division of Toxicology, Leiden/Amsterdam Centre for Drug Research, Leiden University, Einsteinweg 55, 2333CC Leiden, The Netherlands
| | - Bob van de Water
- Division of Toxicology, Leiden/Amsterdam Centre for Drug Research, Leiden University, Einsteinweg 55, 2333CC Leiden, The Netherlands
| | - Leo T M van der Ven
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| |
Collapse
|
32
|
Resuscitation with amiodarone increases survival after hemorrhage and ventricular fibrillation in pigs. J Trauma Acute Care Surg 2014; 76:1402-8. [PMID: 24854308 DOI: 10.1097/ta.0000000000000243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Supplemental digital content is available in the text. BACKGROUND The aim of this experimental study was to compare survival and hemodynamic effects of a low-dose amiodarone and vasopressin compared with vasopressin in hypovolemic cardiac arrest model in piglets. METHODS Eighteen anesthetized male piglets (with a weight of 25.3 [1.8] kg) were bled approximately 30% of the total blood volume via the femoral artery to a mean arterial blood pressure of 35 mm Hg in a 15-minute period. Afterward, the piglets were subjected to 4 minutes of untreated ventricular fibrillation followed by 11 minutes of open-chest cardiopulmonary resuscitation. At 5 minutes, circulatory arrest amiodarone 1 mg/kg was intravenously administered in the amiodarone group (n = 9), while the control group received the same amount of saline (n = 9). At the same time, all piglets received vasopressin 0.4 U/kg intravenously administered and hypertonic-hyperoncotic solution 3-mL/kg infusion for 20 minutes. Internal defibrillation was attempted from 7 minutes of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3 hours after resuscitation. RESULTS Three-hour survival was greater in the amiodarone group (p = 0.02). After the successful resuscitation, the amiodarone group piglets had significantly lower heart rate as well as greater systolic, diastolic, and mean arterial pressure. Troponin I plasma concentrations were lower and urine output was greater in the amiodarone group. CONCLUSION Combined resuscitation with amiodarone and vasopressin after hemorrhagic circulatory arrest resulted in greater 3-hour survival, better preserved hemodynamic parameters, and smaller myocardial injury compared with resuscitation with vasopressin only.
Collapse
|
33
|
Vitins AP, Kienhuis AS, Speksnijder EN, Roodbergen M, Luijten M, van der Ven LTM. Mechanisms of amiodarone and valproic acid induced liver steatosis in mouse in vivo act as a template for other hepatotoxicity models. Arch Toxicol 2014; 88:1573-88. [PMID: 24535564 DOI: 10.1007/s00204-014-1211-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/03/2014] [Indexed: 01/02/2023]
Abstract
Liver injury is the leading cause of drug-induced toxicity. For the evaluation of a chemical compound to induce toxicity, in this case steatosis or fatty liver, it is imperative to identify markers reflective of mechanisms and processes induced upon exposure, as these will be the earliest changes reflective of disease. Therefore, an in vivo mouse toxicogenomics study was completed to identify common pathways, nuclear receptor (NR) binding sites, and genes regulated by three known human steatosis-inducing compounds, amiodarone (AMD), valproic acid (VPA), and tetracycline (TET). Over 1, 4, and 11 days of treatment, AMD induced changes in clinical chemistry parameters and histopathology consistent with steatosis. Common processes and NR binding sites involved in lipid, retinol, and drug metabolism were found for AMD and VPA, but not for TET, which showed no response. Interestingly, the pattern of enrichment of these common pathways and NR binding sites over time was unique to each compound. Eleven biomarkers of steatosis were identified as dose responsive and time sensitive to toxicity for AMD and VPA. Finally, this in vivo mouse study was compared to an AMD rat in vivo, an AMD mouse primary hepatocyte, and a VPA human primary hepatocyte study to identify concordance for steatosis. We conclude that concordance is found on the process level independent of species, model or dose*time point.
Collapse
Affiliation(s)
- Alexa P Vitins
- Center for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands,
| | | | | | | | | | | |
Collapse
|
34
|
KARLIS G, IACOVIDOU N, LELOVAS P, NIFOROPOULOU P, ZACHARIOUDAKI A, PAPALOIS A, SUNDE K, STEEN PA, XANTHOS T. Effects of early amiodarone administration during and immediately after cardiopulmonary resuscitation in a swine model. Acta Anaesthesiol Scand 2014; 58:114-22. [PMID: 24341695 DOI: 10.1111/aas.12226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aim of this experimental study was to compare haemodynamic effects and outcome with early administration of amiodarone and adrenaline vs. adrenaline alone in pigs with prolonged ventricular fibrillation (VF). METHODS After 8 min of untreated VF arrest, bolus doses were administered of adrenaline (0.02 mg/kg) and either amiodarone (5 mg/kg) or saline (n = 8 per group) after randomisation. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration, and defibrillation was attempted 2 min later. CPR was resumed for another 2 min after each defibrillation attempt, and the same dose of adrenaline was given every 4th minute during CPR. Haemodynamic monitoring and mechanical ventilation continued for 6 h after return of spontaneous circulation (ROSC), and the pigs were euthanised at 48 h. Researchers were blinded for drug groups throughout the study. RESULTS There was no difference in rates of ROSC and 48-h survival with amiodarone vs. saline (5/8 vs. 7/8 and 0/8 vs. 3/8, respectively). Diastolic aortic pressure and coronary perfusion pressure were significantly lower with amiodarone during CPR and 1 min after ROSC (P < 0.05). The number of electric shocks required for terminating VF, time to ROSC and adrenaline dose were significantly higher with amiodarone (P < 0.01). The incidence of post-resuscitation tachyarrhythmias tended to be higher in the saline group (P = 0.081). CONCLUSION Early administration of amiodarone did not improve ROSC or 48-h survival rates, and was associated with worse haemodynamics in this swine model of cardiac arrest.
Collapse
Affiliation(s)
- G. KARLIS
- 2nd Department of Internal Medicine; Sismanoglio General Hospital; Athens Greece
| | - N. IACOVIDOU
- Medical School; University of Athens; Athens Greece
| | - P. LELOVAS
- Medical School; University of Athens; Athens Greece
| | | | - A. ZACHARIOUDAKI
- Experimental-Research Center; ELPEN Pharmaceutical; Athens Greece
| | - A. PAPALOIS
- Experimental-Research Center; ELPEN Pharmaceutical; Athens Greece
| | - K. SUNDE
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; University of Oslo; Oslo Norway
| | - P. A. STEEN
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; University of Oslo; Oslo Norway
| | - T. XANTHOS
- Medical School; University of Athens; Athens Greece
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Many causes of toxic optic neuropathy have been described to date and novel causes of toxicity are continuously being added to the current literature. The pathophysiological basis for the toxicity or a direct causal relationship is yet to be determined for many of these agents. This review highlights the reports made over the last year about the commonly reported agents, with emphasis on the mechanisms of toxicity. RECENT FINDINGS Mitochondria of retinal ganglion cells and papillomacular bundle in particular could be the common target of many causes of toxic optic neuropathy, if not all. Agents or their metabolites responsible for the toxicity seem to interfere with the oxidative phosphorylation in mitochondria, causing a buildup of reactive oxidation species, energy depletion, oxidative stress, and activation of apoptosis. SUMMARY Further data are still necessary to understand how some of the usual suspects cause damage to the optic nerve or whether they indeed cause damage or not. A basic algorithm, as proposed, could be a useful addition to discriminate the novel causes of toxic optic neuropathy. VIDEO ABSTRACT See the Supplemental Digital Content 1 (http://links.lww.com/COOP/A11).
Collapse
|
36
|
Obel O, Joglar JA. Unveiling the remodeled atrium: lessons from the early recurrence of atrial fibrillation. J Cardiovasc Electrophysiol 2013; 25:168-70. [PMID: 24237906 DOI: 10.1111/jce.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Owen Obel
- Division of Cardiology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | |
Collapse
|
37
|
Del Tredici AL, Ma JN, Piu F, Burstein ES. Identification of the antiarrhythmic drugs amiodarone and lorcainide as potent H3 histamine receptor inverse agonists. J Pharmacol Exp Ther 2013; 348:116-24. [PMID: 24204014 DOI: 10.1124/jpet.113.208892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Use of molecular pharmacology to reprofile older drugs discovered before the advent of recombinant technologies is a fruitful method to elucidate mechanisms of drug action, expand understanding of structure-activity relationships between drugs and receptors, and in some cases, repurpose approved drugs. The H3 histamine receptor is a G-protein-coupled receptor (GPCR) primarily expressed in the central nervous system where among many things it modulates cognitive processes, nociception, feeding and drinking behavior, and sleep/wakefulness. In binding assays and functional screens of the H3 histamine receptor, the antiarrhythmic drugs lorcainide and amiodarone were identified as potent, selective antagonists/inverse agonists of human and rat H3 histamine receptors, with relatively little or no activity at over 20 other monoamine GPCRs, including H1, H2, and H4 receptors. Potent antagonism of H3 receptors was unique to amiodarone and lorcainide of 20 antiarrhythmic drugs tested, representing six pharmacological classes. These results expand the pharmacophore of H3 histamine receptor antagonist/inverse agonists and may explain, in part, the effects of lorcainide on sleep in humans.
Collapse
|
38
|
Xia Y, Qu W, Zhao LN, Han H, Yang XF, Sun XF, Hao LP, Xu J. Iodine excess induces hepatic steatosis through disturbance of thyroid hormone metabolism involving oxidative stress in BALB/c mice. Biol Trace Elem Res 2013; 154:103-10. [PMID: 23712835 DOI: 10.1007/s12011-013-9705-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 09/27/2012] [Indexed: 11/27/2022]
Abstract
Iodine excess is emerging as a new focus. A better understanding of its hazardous effects on the liver will be of great benefit to health. The aim of this study is to illustrate the effects of iodine excess on hepatic lipid homeostasis and explore its possible mechanisms. One hundred twenty BaLB/c mice were given iodine at different levels (0, 0.3, 0.6, 1.2, 2.4, and 4.8 mg I/L) in drinking water for 1 or 3 months. Lipid parameters and serum thyroid hormones were measured. Hepatic type 1 deiodinase activity and oxidative stress parameters were evaluated. The mRNA expression of sterol regulatory element-binding protein-1c (SREBP-1c) and fatty acid synthase (FAS) was detected by real-time polymerase chain reaction. Dose-dependent increase of hepatic triglyceride content was detected (r = 0.680, P < 0.01) in iodine-loaded groups. Evident hepatic steatosis was observed in 2.4 and 4.8 mg I/L iodine-loaded groups. The activities of antioxidant enzymes (glutathione peroxidase and superoxide dismutase) were decreased, and the malondialdehyde level was increased by excessive iodine in both serum and liver in a dose-dependent manner, accompanying the decrease of hepatic D1 activity. That resulted in the increase of serum total thyroxine and the decrease of serum total triiodothyronine in iodine-loaded groups. The mRNA expression of SREBP-1c and FAS was increased in iodine-loaded groups in response to the change of serum triiodothyronine. Present findings demonstrated that iodine excess could dose dependently induce hepatic steatosis. Furthermore, our data suggested that the disturbance of thyroid hormone metabolism involving oxidative stress may play a critical role in iodine excess-induced hepatic steatosis.
Collapse
Affiliation(s)
- Yun Xia
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | | | | | | | | | | | | | | |
Collapse
|
39
|
The protective effect of amiodarone in lung tissue of cecal ligation and puncture-induced septic rats: a perspective from inflammatory cytokine release and oxidative stress. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2013; 386:635-43. [DOI: 10.1007/s00210-013-0862-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 03/22/2013] [Indexed: 10/27/2022]
|
40
|
Chinitz JS, Vaishnava P, Narayan RL, Fuster V. Atrial fibrillation through the years: contemporary evaluation and management. Circulation 2013; 127:408-16. [PMID: 23339095 DOI: 10.1161/circulationaha.112.120758] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jason S Chinitz
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, NY 10029, USA
| | | | | | | |
Collapse
|
41
|
|
42
|
|