Abstract
Purpose: Atrial fibrillation (AF) is a fairly common complication of acute myocardial infarction (AMI). The aim of this study was to examine the safety and efficacy of intravenous amiodarone in converting AF associated with AMI.
Methods: Seventy patients with AMI complicated with AF were prospectively divided into 3 groups: a) In group D (n = 26), 0.75 mg digoxin was administered intravenously and thereafter as needed, b) In group AM (n = 16), 300 mg of amiodarone was infused over 2 hours followed by 44 mg/hour for up to 60 hours or until sinus rhythm was restored, c) In group D + AM (n = 28), 0.75 mg of digoxin was administered (as in group D) for the initial 2 hours followed by amiodarone infusion as in group AM.
Results: Sinus rhythm was restored: a) by the end of the 2nd hour in 9/26 patients from group D, 4/16 from group AM, and 10/28 from group D + AM (p = NS), b) by the end of the 96th hour, in 18/26 patients from group D, and in all patients from group AM and groupd D + AM. The corresponding duration of AF was 51 ± 34 hours, 17 ± 15 hours and 9 ± 13 hours, respectively (F = 15.4, p < 0.001). AF recurred in 9/26, 5/16 and 1/28 patients of groups D, AM and D + AM, respectively (p = 0.026). The required dosage of amiodarone was lower in the D + AM group than in the AM group (603 ± 563 mg versus 1058 ± 680 mg, p = 0.037).
Conclusions: Intravenous amiodarone was well tolerated in patients with AMI complicated by AF and was effective in decreasing the duration of AF. However, the combination of amiodarone and digoxin was superior to amiodarone alone in restoring sinus rhythm faster, maintaining sinus rhythm longer, and allowing the use of a lower cumulative amount of amiodarone.
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References
Behar S, Zahavi Z, Goldbourt U, Reicher-Reiss H and the Sprint Study Group. Long-term prognosis of patients with paroxysmal atrial fibrillation complicating acute myocardial infarction. Eur Heart J 1992; 13: 45-50.
The Lusto Investigators. An international randomised trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329:6 73-86.
Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHAguidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1996; 28:1 328-428.
Graettinger JS, Carleton RA, Muenster JJ. Circulatory consequences of changes in cardiac rhythm produced in patients by transthoracic direct current shock. J Clin Invest 1964; 43:2 290-302.
Killip T, Baer RA. Hemodynamic effects after reversion from atrial fibrillation to sinus rhythm by precordial shock. J Clin Invest 1966; 45:6 58-71.
Pritchett EL. Management of atrial fibrillation. N Engl J Med 1992; 326:12 64-71.
Selzer A, Wray HW. Quinidine syncope: Paroxysmal ventricular fibrillation occurring during treatment of chronic atrial arrhythmias. Circulation 1964; 30: 17-26.
Falk RH. Flecainide-induced ventricular tachycardia and fibrillation in patients treated for atrial fibrillation. Ann Intern Med 1989; 111:1 07-11.
Sideris DA, Kontoyannis DA, Moulopoulos SD. Torsade des pointes and aprindine. Int J Cardiol 1985; 7: 413-416.
Molstad P. Digitalis in patients after myocardial infarction. Herz 1993; 18:1 18-23.
Smith TW. Digitalis. Mechanisms of action and clinical use. N Engl J Med 1988; 318:3 58-65.
Hoffman BF, Bigger T. Digitalis and allied cardiac glycosides. In: Goodman LS and Gilmans A, eds. The Pharmacological Basis of Therapeutics.NY: Pergamon Press, 1990: 8 14-39.
Kober L, Torp-Pedersen C, Gadsboll N, Hildebrandt P, Hoilund-Garlsen PF. Is digoxin an independent risk factor for long-term mortality after acute myocardial infarction? Eur Heart J 1994; 15:3 82-88.
Kopelman HA, Horowitz LN. Efficacy and toxicity of amiodarone for the treatment of supraventricular tachyarrhythmias. Prog Cardiovasc Dis 1989; 31:3 55-66.
Mason JW. Amiodarone. N Engl J Med 1987; 316:4 55-66.
Anastasiou-Nana M, Levis G, Moulopoulos S. Pharmacokinetics of amiodarone after intravenous and oral administration. Int J Clin Pharmac Ther Toxicol 1982; 20:5 24-29.
Remme WJ, Kruyssen HA, Look MP, Hoogenhuyze DC, Krauss XH. Hemodynamic effects and tolerability of intravenous amiodarone in patients with impaired left ventricular function. Am Heart J 1991; 122: 96-103.
Shaikh NA, Downar E, Butany J. Amiodarone-an inhibitor of phospholipase activity: A comparative study of the inhibitory effects of amiodarone, chloroquine and chlorpromazine. Mol Cell Biochem 1987; 76:1 63-72.
Singh BN, VaughanWilliams EM. The effect of amiodarone, a new antianginal drug, on cardiac muscle. Br J Pharmacol 1970; 39:6 57-67.
Mason JW, Hondeghem LM, Katzung BG. Block of inactivated sodium channels and of depolarization-induced automaticity in guinea pig papillary muscle by amiodarone. Circ Res 1984; 55:2 77-85.
Hohnloser S, Meinertz T, Dammbacher T, et al. Electrocardiographic and antiarrhythmic effects of intravenous amiodarone: Results of a prospective, placebo controlled study. Am Heart J 1991; 121: 89-95.
Anastasiou-Nana M, Nanas J, Nanas S, et al. Effects of amiodarone on refractory ventricular fibrillation in acute myocardial infarction: Experimental study. J Am Coll Cardiol 1994; 23:2 53-58.
Venkatesh N, Padbury JF, Singh BN. Effects of amiodarone and desethylamiodarone on rabbit myocardial betaadrenoceptors and serum thyroid hormones-absence of relationship to serum and myocardial drug concentrations. J Cardiovasc Pharmacol 1986; 8:9 89-97.
Chapman MJ, Moran JL, O'Fathartaigh MS, Peisach AR, Cunningham DN. Management of atrial tachyarrhythmias in the critically ill: A comparison of intravenous procainamide and amiodarone. Intens Care Med 1993; 19: 48-52.
Leak D. Intravenous amiodarone in the treatment of refractory life-threatening cardiac arrhythmias in the critically ill patient. Am Heart J 1986; 111:4 56-62.
Galve E, Rius T, Ballester R, et al. Intravenous amiodarone in treatment of recent-onset atrial fibrillation: Results of a randomized, controlled study. J Am Coal Cardiol 1996; 27:10 79-82.
Kerin NZ, Faitel K, Naini M. The efficacy of intravenous amiodarone for the conversion of chronic atrial fibrillation. Arch Intern Med 1996; 156: 49-53.
Kontoyannis DA, Anastasiou-Nana MI, Kontoyannis SA, Nanas JN, Kalabalikis A, Moulopoulos SD. Intravenous amiodarone restores sinus rhythm in acute myocardial infarction complicated with atrial fibrillation. J Am Coll Cardiol 1995; 26: 901 (abstr).
Gosselink AM, Crijns HJ, Van Gelder IC, Hillige H, Wiesfeld A, Lie K. Low dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. J Am Med Assoc 1992; 267:32 89-93.
Cowan JC, Gardiner P, Reid DS, Newell DJ, Cambell RW. A comparison of amiodarone and digoxin in the treatment of atrial fibrillation complicating suspected acute myocardial infarction. J Cardiovasc Pharmacol 1986; 8:2 52-56.
Blandford RL, Crampton J, Kudlac H. Intravenous amiodarone in atrial fibrillation complicating myocardial infarction. Br Med J 1982; 284: 16-17.
Hohnloser SH, Zabel M, Zehender M, Meinertz T, Just H. Efficacy of intravenously administered amiodarone for short-term control of serious arrhythmias. J Cardiovasc Pharmacol 1992; 20(Suppl. 2): S63-69.
Falk RH, Knowlton AA, Bernard SA, Gotlieb NE, Battinelli NJ. Digoxin for converting recent onset atrial fibrillation to sinus rhythm. A randomized, double-blinded trial. Ann Intern Med 1987; 106:5 03-06.
Levy S, Ricard P. Using the right drug: A treatment algorithm for regular supraventricular tachycardias. Eur Heart J 1997; 18(Suppl C): C27-32.
Mostow Nd, Rakita L, Vrobel DR, Noon D, Blumer J. Amiodarone: Intravenous loading for rapid suppression of complex ventricular arrhythmias. J Am Coll Cardiol 1984; 4: 97-104.
Helmy I, Herre JM, Gee G, et al. Use of intravenous amiodarone for emergency treatment of life threatening ventricular arrhythmias. J Am Coll Cardiol 1988; 12:10 15-22.
Ochi RP, Goldenberg IF, Almquist A, et al. Intravenous amiodarone for the rapid treatment of life threatening ventricular arrhythmias in critically ill patients with coronary artery disease. Am J Cardiol 1989; 64: 599-603.
Kusniec J, Strasberg B, Sclarovsky S, Klainman, Amgon J. The effect of intravenous amiodarone on heart rate in patients with acute myocardial infarction or ischemia and sinus tachycardia. Chest 1988; 94:5 84-88.
Charlier R. Cardiac actions in the dog of a new antagonist of adrenergic excitation which does not produce competitive blockade of adrenoceptors. Br J Pharmacol 1970; 39:6 68-74.
Kosinski EJ, Albin JB, Young E, Lewis SM, Leland SJ. Hemodynamic effects of intravenous amiodarone. J AmColl Cardiol 1984; 4:5 65-70.
Nalos PC, Ismail Y, Pappas JM, Nyitray W, DonMichael AT. Intravenous amiodarone for short-term treatment of refractory ventricular tachycardia or fibrillation. Am Heart J 1991; 122:16 29-32.
Hondeghem LM, Snyders DJ. Class III antiarrhythmic agents have a lot of potential but a long way to go. Reduced effectiveness and dangers of reverse use dependence. Circulation 1990; 81:6 86-90.
Gagnol JP, Devos C, Clinet M, Nokin P. Amiodarone: Biochemical aspects and haemodynamic effects. Drugs 1985; 29(Suppl 3): 1-10.
Haworth RA, Goknur AB, Berkoff HA. Inhibition of ATPsensitive potassium channels of adult rat heart cells by antiarrhythmic drugs. Circ Res 1989; 65:11 57-60.
Nanas JN, Mason JW. Pharmacokinetics and regional electrophysiological effects of intracoronary amiodarone administration. Circulation 1995; 91:4 51-61.
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Kontoyannis, D.A., Anastasiou-Nana, M.I., Kontoyannis, S.A. et al. Intravenous Amiodarone Decreases the Duration of Atrial Fibrillation Associated with Acute Myocardial Infarction. Cardiovasc Drugs Ther 15, 155–160 (2001). https://doi.org/10.1023/A:1011127030014
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DOI: https://doi.org/10.1023/A:1011127030014