Amiodarone ; administration & dosage ; Anti-Arrhythmia Agents ; administration & dosage ; Atrial Fibrillation ; drug therapy ; Heart Valve Diseases ; drug therapy ; Humans ; Quality of Life ; Rheumatic Heart Disease ; drug therapy

OBJECTIVETo probe the feasibility of acupuncture in conversion of paroxymal atrial fibrillation and atrial flutter.

METHODSEighty cases of atrial fibrillation and atrial flutter were randomly divided into 2 groups, a treatment group and a control group, 40 cases in each group. The treatment group were treated with acupuncture at Neiguan (PC 6), Shenmen (HT 7), Danzhong (CV 17) and others, and the control group with intravenous injection of amiodarone. The cardiac rhythms and side effects were observed in the two groups.

RESULTSThe total effective rate of 85.0% in the treatment group was better than 67.5% in the control group (P < 0.01). The average conversion time was (39.6 +/- 13.7) min in the treatment group and (50.1 +/- 14.8) min in the control group with a significant difference between the two groups (P < 0.01). No adverse effect was found in the treatment group.

CONCLUSIONAcupuncture is a safe and effective therapy for conversion of paroxymal atrial fibrillation and atrial flutter.

Acupuncture Therapy ; Aged ; Amiodarone ; administration & dosage ; therapeutic use ; Anti-Arrhythmia Agents ; therapeutic use ; Atrial Fibrillation ; therapy ; Atrial Flutter ; therapy ; Female ; Humans ; Injections, Intravenous ; Male ; Middle Aged

BACKGROUNDAtrial fibrillation (AF) is one of the most common arrhythmia after coronary artery bypass grafting (CABG), which not only increases the suffering of the patients, but also prolongs hospital stay and enhances cost of care, especially for patients older than 70 years. This study was designed to evaluate the efficacy and safety of low-dose amiodarone in the prevention of AF after CABG, especially for the elderly.

METHODSTwo hundred and ten senile patients undergoing off-pump CABG were included in this prospective, randomized, double-blind and placebo controlled study. Patients were given 10 mg/kg of amiodarone (low-dose amiodarone group, n = 100) or placebo (control group, n = 110) daily for 7 days before surgery and followed by 200 mg of amiodarone or placebo daily for 10 days postoperatively.

RESULTSPostoperative AF occurred in 16 patients (16%) receiving amiodarone and in 36 (37.7%) patients receiving placebo (P = 0.006). AF occurred at (58.13 +/- 16.63) hours after CABG in the low-dose amiodarone group and at (45.03 +/- 17.40) hours in the control group (P = 0.018). The maximum ventricular rate during AF was significantly slower in the low-dose amiodarone group ((121.42 +/- 28.91) beats/min) than in the control group ((134.11 +/- 30.57) beats/min, P = 0.036). The duration of AF was (10.92 +/- 9.56) hours for the low-dose amiodarone group compared with (14.81 +/- 10.37) hours for the control group (P = 0.002). The postoperative left ventricular ejection fraction (LVEF) was significantly improved in the low-dose amiodarone group (from (59.9 +/- 10.3)% to (63.4 +/- 11.4)%, P = 0.001), and significantly higher compared with the control group ((58.5 +/- 10.7)%, P = 0.002). Both groups had a similar incidence of complication other than rhythm disturbances (12.0% vs 16.4%, P = 0.368). The low-dose amiodarone group patients had shorter hospital stays ((11.8 +/- 3.2) days vs (13.8 +/- 4.7) days, P = 0.001) and lower cost of care (RMB (79 115 +/- 16 673) Yuan vs RMB (84 997 +/- 21 587) Yuan, P = 0.031) than that of control group patients. The in-hospital mortality was not significantly different between the two groups (1.0% vs 0.9%, P = 0.946).

CONCLUSIONSPerioperative low-dose oral amiodarone appeared to be cost-effective in the prevention and delay of new-onset postoperative AF in aged patients. It significantly reduced ventricular rate and duration of AF after CABG, decreased hospital cost and stay, as well as promoted the amelioration of left ventricular systolic function. Furthermore, low-dose amiodarone was safe to use and well tolerated with low toxic and side effects, and did not increase the risk of complications and mortality. It is proved to be a first-line therapy and as routine prophylaxis for AF after CABG, especially for elderly patients complicated with left ventricular dysfunction.

Aged ; Amiodarone ; administration & dosage ; Anti-Arrhythmia Agents ; administration & dosage ; Atrial Fibrillation ; etiology ; prevention & control ; Coronary Artery Bypass ; adverse effects ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Male ; Treatment Outcome

OBJECTIVETo observe the therapeutic efficacy and safety of amiodarone combined with Shenmai Injection (参麦注射液) on atrial fibrillation.

METHODSA total of 351 patients with atrial fibrillation caused by cardiovascular diseases and idiopathic atrial fibrillation were assigned to amiodarone group (control group, 128 cases) and amiodarone combined with Shenmai Injection group (treatment group, 223 cases). The patients in the control group received intravenous injection of 150 mg amiodarone in 10 min, followed by intravenous drip infusion at 1 mg /min and 6 h later at 0.5 mg /min until 48 h or cardioversion. The patients in the treatment group received the same treatment of amiodarone, while in addition, they received an injection of Shenmai Injection of 100 mL simultaneously. Blood pressure, ventricular rate, and cardioversion were observed.

RESULTSThe total efficiency rate was 98% (control group) and 99% (treatment group) (P>0.05). The mean ventricular rate decreased 23% and 31% in the control group and the treatment group, respectively (P<0.05). The mean cardioversion time of the two groups was 570±211 min and 351±123 min, respectively (P<0.05). Only mild side effects were observed in both groups.

CONCLUSIONCompared with amiodarone, amiodarone combined with Shenmai Injection takes effect more quickly with low side effects on the treatment of atrial fibrillation.

Aged ; Aged, 80 and over ; Amiodarone ; administration & dosage ; adverse effects ; therapeutic use ; Anti-Arrhythmia Agents ; administration & dosage ; adverse effects ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDLong-term maintenance of sinus rhythm after successful conversion of chronic atrial fibrillation (CAF), often ameliorates patients' symptoms, reduces the risk of ischemic stroke and improves cardiovascular hemodynamics. This prospective study aims to evaluate the long-term efficacy and safety of very low-dose amiodarone (100 mg daily) for the maintenance of sinus rhythm after successful direct-current (DC) cardioversion in patients with CAF and rheumatic heart disease (RHD) post intervention.

METHODSThis study was a randomized prospective trial. One day after successful DC cardioversion (remained normal sinus rhythm) in patients with CAF and RHD post intervention for more than six months and adequate anticoagulation, all were randomly administered either amiodarone 200 mg daily in group A or amiodarone 100 mg daily in group B.

RESULTSA total of 76 patients (40 men and 36 women) were examined from February 1998 to December 1999. The mean age of the patients was (66 +/- 10) years, and the mean follow-up was (67 +/- 8) months (range 61 to 84 months). Actuarial rates of the maintenance of sinus rhythm were similar in the two groups after 5 years of follow-up. Four patients (11%) in group A but none in group B experienced significant adverse effects that necessitated withdrawal of amiodarone. No death occurred during the study period.

CONCLUSIONA very low dose of amiodarone results in adequate long-term efficacy and is safe for maintaining sinus rhythm in patients with CAF and RHD post intervention after successful DC cardioversion.

Aged ; Amiodarone ; administration & dosage ; adverse effects ; Anti-Arrhythmia Agents ; administration & dosage ; Arrhythmia, Sinus ; drug therapy ; Atrial Fibrillation ; drug therapy ; physiopathology ; Chronic Disease ; Cohort Studies ; Electric Countershock ; methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies

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.
Aged ; Amiodarone/administration & dosage/*adverse effects ; Anti-Arrhythmia Agents/administration & dosage/*adverse effects ; Arrhythmias, Cardiac/drug therapy ; Atrioventricular Block/chemically induced/epidemiology ; Bradycardia/chemically induced/epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Risk Factors

BACKGROUND: Determining the precise magnitude, duration, and mechanism of hypotension caused by intravenous amiodarone could potentially increase the safety of drug administration to critically ill patients. The objective of this study was to characterize the immediate cardiovascular actions of an intravenous loading dose of amiodarone administered using echocardiographic and hemodynamic measurements. METHODS: In a prospective double-blind trial, 20 patients undergoing off-pump coronary artery bypass graft surgery were randomly assigned to receive intravenous amiodarone (n = 10) or placebo (n = 10). Heart rate (HR), arterial blood pressure (systolic, diastolic, mean; SAP, DAP, MAP), pulmonary artery pressure (systolic, diastolic, mean; PSAP, PDAP, PMAP), cardiac output (CO), central venous pressure (CVP), left ventricular ejection fraction (LVEF) were measured. RESULTS: HR, SAP, DAP, MAP, PSAP, PDAP, PMAP, CO by thermodilution method, CVP, LVEF by echocardiographic measurements was not significantly different in both group. Hypotension requiring intervention occurred in 2 of 10 patients after amiodarone administration and in none of 10 patients after placebo. CONCLUSIONS: Hypotension requiring intervention occurred 20% after amiodarone administration, the cause of these hypotension were thought to be arterial dilatation but was not associated with decreased cardiac output or left ventricular ejection fraction and corrected successfully by intravenous administration of phenylephrine.
Administration, Intravenous ; Amiodarone* ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump ; Critical Illness ; Dilatation ; Echocardiography* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Myocardial Ischemia ; Phenylephrine ; Prospective Studies ; Pulmonary Artery ; Stroke Volume ; Thermodilution ; Transplants