The use of intravenous amiodarone in patients with atrial fibrillation and Wolff-Parkinson-White syndrome

Link to article at PubMed

Pacing Clin Electrophysiol. 2020 Oct 29. doi: 10.1111/pace.14113. Online ahead of print.


BACKGROUND: It was reported that intravenous amiodarone might induce ventricular fibrillation for acute treatment in patients with atrial fibrillation (AF) and Wolff-Parkinson-White (WPW) syndrome. No study was done to assess its application comprehensively in this population.

METHODS: This study was a retrospective analysis and undertaken by reviewing medical records and electronic databases to search for patients admitted with tachycardia resulting from WPW syndrome and AF, who have intravenously administrated amiodarone at the emergency department from January 2008 to June 2018.

RESULTS: 30 patients were involved in this study, of which 27 were males. The mean age of the patients was 47.8±17.0 years. The mean systolic blood pressure and diastolic blood pressure were 111.9±18.3mmHg and 76.1±14.6mmHg, respectively. The mean heart rate was 171[150-189]beats per minute. Half of the patients (53.3%) had no comorbidities, and only one had prior syncope. Nearly 17 patients (56.7%) started with a loading dose of 150mg. No ventricular acceleration or VF developed. The incidence of hypotension was 3.3% (1/30). Eighteen patients (60.0%) restored to sinus rhythm by amiodarone with the conversion time of 486.0[229.0-1278.0] minutes.

CONCLUSIONS: Intravenous amiodarone might be an alternative for acute treatment of AF and WPW syndrome in patients characterized by stable hemodynamics, relatively low admission heart rate, few comorbidities, elder age, and no prior syncope. The loading dosage of 150mg appeared to be preferred, and the maintenance period was better to less than 12 hours. Monitoring and electrolyte correction were also necessary. It is essential to keep a defibrillator nearby during pharmacologic cardioversion. This article is protected by copyright. All rights reserved.

PMID:33118640 | DOI:10.1111/pace.14113

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