New study Regarding the use of amiodarone for various arrhythmias.
التاريخ:
2007-09-26
<p>
Although amiodarone is approved by the US Food<sup> </sup>and Drug Administration only for refractory ventricular arrhythmias,<sup> </sup>it is one of the most frequently prescribed antiarrhythmic medications<sup> </sup>in the United States.<sup> </sup>
</p>
<p>Objective was To evaluate and synthesize evidence regarding<sup> </sup>optimal use of amiodarone for various arrhythmias.<sup> </sup></p>
<p>Systematic search of MEDLINE to identify<sup> </sup>peer-reviewed clinical trials, randomized controlled trials,<sup> </sup>meta-analyses, and other studies with clinical pertinence. The<sup> </sup>search was limited to human-participant, English-language reports<sup> </sup>published between 1970 and 2007. Amiodarone was searched using<sup> </sup>the terms <i>adverse effects</i>, <i>atrial fibrillation</i>, <i>atrial flutter</i>,<sup> </sup><i>congestive heart failure</i>, <i>electrical storm</i>, <i>hypertrophic cardiomyopathy</i>,<sup> </sup><i>implantable cardioverter-defibrillator</i>, <i>surgery</i>, <i>ventricular<sup> </sup>arrhythmia</i>, <i>ventricular fibrillation</i>, and <i>Wolff-Parkinson-White</i>.<sup> </sup>Bibliographies of identified articles and guidelines from official<sup> </sup>societies were reviewed for additional references. Ninety-two<sup> </sup>identified studies met inclusion criteria and were included<sup> </sup>in the review.<sup> </sup></p>
<p>Amiodarone may have clinical value<sup> </sup>in patients with left ventricular dysfunction and heart failure<sup> </sup>as first-line treatment for atrial fibrillation, though other<sup> </sup>agents are available. Amiodarone is useful in acute management<sup> </sup>of sustained ventricular tachyarrythmias, regardless of hemodynamic<sup> </sup>stability. The only role for prophylactic amiodarone is in the<sup> </sup>perioperative period of cardiac surgery. Amiodarone may be effective<sup> </sup>as an adjunct to implantable cardioverter-defibrillator therapy<sup> </sup>to reduce number of shocks. However, amiodarone has a number<sup> </sup>of serious adverse effects, including corneal microdeposits<sup> </sup>(>90%), optic neuropathy/neuritis ( 1%-2%), blue-gray skin<sup> </sup>discoloration (4%-9%), photosensitivity (25%-75%), hypothyroidism<sup> </sup>(6%), hyperthyroidism (0.9%-2%), pulmonary toxicity (1%-17%),<sup> </sup>peripheral neuropathy (0.3% annually), and hepatotoxicity (elevated<sup> </sup>enzyme levels, 15%-30%; hepatitis and cirrhosis, <3% [0.6%<sup> </sup>annually]).<sup> </sup></p>
<p>Amiodarone should be used with close follow-up<sup> </sup>in patients who are likely to derive the most benefit, namely<sup> </sup>those with atrial fibrillation and left ventricular dysfunction,<sup> </sup>those with acute sustained ventricular arrhythmias, those about<sup> </sup>to undergo cardiac surgery, and those with implantable cardioverter-defibrillators<sup> </sup>and symptomatic shocks.<sup> </sup></p>
<p><font ><i>source :JAMA.</i> <i>2007;298:1312-1322. </i></font><sup></sup></p>
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