Advertisement

Pediatric Cardiology

, Volume 39, Issue 5, pp 1016–1022 | Cite as

Efficacy and Safety of Low-Dose Amiodarone Therapy for Tachyarrhythmia in Congenital Heart Disease

  • Shinya Iwasawa
  • Tomomi Uyeda
  • Mika Saito
  • Taku Ishii
  • Akio Inage
  • Yuji Hamamichi
  • Satoshi Yazaki
  • Tadahiro Yoshikawa
Original Article

Abstract

Amiodarone (AMD) is a class III anti-arrhythmic drug that is highly effective for tachyarrhythmia treatment. AMD is widely used in adults with congenital heart disease (CHD); however, higher doses of AMD (> 200 mg/day) can cause various non-cardiac side effects. The purpose of this study was to assess the efficacy, safety, and adverse events of low-dose AMD (≤ 200 mg/day) for tachyarrhythmia in patients with CHD. We retrospectively studied 80 patients with CHD and tachyarrhythmia who received oral low-dose AMD (≤ 200 mg/day) from January 2004 to March 2016. Low-dose AMD therapy was used to treat supraventricular tachycardia (SVT) in 51 patients and ventricular tachycardia (VT) in 29 patients. After a mean follow-up of 2.9 years for SVT and 3.2 years for VT, 36% and 65% of the patients with SVT and VT, respectively, were free from a first tachyarrhythmia recurrence for 3 years. The incidence of AMD-induced side effects was 23%, and all these cases consisted of thyroid dysfunction. Low-dose AMD was effective for the treatment of tachyarrhythmia in patients with CHD and had a relatively low incidence of side effects. These findings suggest that low-dose AMD is useful and effective for decreasing the frequency of tachyarrhythmia in patients with CHD and has a low incidence of side effects.

Keywords

Congenital heart disease Tachyarrhythmia Anti-arrhythmic drug Amiodarone 

Notes

Compliance with Ethical Standards

Conflict of interest

None of the authors have conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Von der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Tallenberg JJ, Roos-Hesselink JW (2011) Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 58:2241–2247.  https://doi.org/10.1016/j.jacc.2011.08.025 CrossRefPubMedGoogle Scholar
  2. 2.
    Marelli AJ, Mackie AS, Inescu-Ittu R, Rahme E, Pilote L (2007) Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 115:163–172.  https://doi.org/10.1161/CIRCULATIONAHA.106.627224 CrossRefPubMedGoogle Scholar
  3. 3.
    Koyak Z, Harris L, de Groot JR, Silversides CK, Oechslin EN, Bouma BJ, Budts W, Zwinderman AH, Van Gelder IC, Mulder BJ (2012) Sudden cardiac death in adult congenital heart disease. Circulation 126:1944–1954.  https://doi.org/10.1161/CIRCULATIONAHA.112.104786 CrossRefPubMedGoogle Scholar
  4. 4.
    Engelfriet P, Boersma E, Oechslin E, Tijssen J, Gatzoulis MA, Thilén U, Kaemmerer H, Moons P, Meijboom F, Popelová J, Laforest V, Hirsch R, Daliento L, Thaulow E, Mulder B (2005) The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 years follow-up period: The Euro Heart Survey on adult congenital heart disease. Eur Heart J 26:2325–2333.  https://doi.org/10.1093/eurheartj/ehi396 CrossRefPubMedGoogle Scholar
  5. 5.
    Yap SC, Harris L, Chauhan VS, Oechslin EN, Silversides CK (2011) Identifying high risk in adults with congenital heart disease and atrial arrhythmias. Am J Cardiol 108:723–728.  https://doi.org/10.1016/j.amjcard.2011.04.021 CrossRefPubMedGoogle Scholar
  6. 6.
    Coumel P, Fidelle J (1980) Amiodarone in the treatment of cardiac arrhythmias in children: one hundred thirty-five cases. Am Heart J 100:1063–1069CrossRefPubMedGoogle Scholar
  7. 7.
    Garson A, Gillette PC, McVey P, Hesslein PS, Porter CBJ, Angell LK, Kaldis LC, Hittner HM (1984) Amiodarone treatment of critical arrhythmias in children and young adults. J Am Coll Cardiol 4:749–755CrossRefPubMedGoogle Scholar
  8. 8.
    Vorperian VR, Havighurst TC, Miller S, January CT (1997) Adverse effects of low dose amiodarone: a meta-analysis. J Am Coll Cardiol 30:791–798CrossRefPubMedGoogle Scholar
  9. 9.
    Jafari-Fesharaki M, Scheinmann MM (1998) Adverse effects of amiodarone. Pacing Clin Electrophysiol 21:108–120CrossRefPubMedGoogle Scholar
  10. 10.
    Mason JW (1987) Amiodarone. N Engl J Med 316:455–466CrossRefPubMedGoogle Scholar
  11. 11.
    Raeder EA, Podrid PJ, Lown B (1985) Side effects and complications of amiodarone therapy. Am Heart J 109:975–983CrossRefPubMedGoogle Scholar
  12. 12.
    Amiodarone Trials Meta-Analysis Investigators (1997) Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomized trials. Lancet 350:1417–1424CrossRefGoogle Scholar
  13. 13.
    Lewis JH, Ranard RC, Caruso A, Jackson LK, Mullick F, Ishak KG, Seeff LB, Zimmerman HJ (1989) Amiodarone hepatotoxicity: prevalence and clinicopathologic correlations among 104 patients. Hepatology 9:679–685CrossRefPubMedGoogle Scholar
  14. 14.
    Richer M, Robert S (1995) Fatal hepatotoxicity following oral administration of amiodarone. Ann Pharmacother 29:582–586CrossRefPubMedGoogle Scholar
  15. 15.
    Thorne SA, Barnes I, Cullinan P, Somerville J (1999) Amiodarone-associated thyroid dysfunction: risk factors in adults with congenital heart disease. Circulation 100:149–154CrossRefPubMedGoogle Scholar
  16. 16.
    Guccione P, Paul T, Garson A (1990) Long-term follow-up of amiodarone therapy in the young: continued efficacy, unimpaired growth, and moderate side effects. J Am Coll Cardiol 15:1118–1124CrossRefPubMedGoogle Scholar
  17. 17.
    Takeuchi D, Honda K, Shinohara T, Inai K, Toyohara K, Nakanishi T (2015) Incidence, clinical course, and risk factors of amiodarone-induced thyroid dysfunction in Japanese adults with congenital heart disease. Circ J 79:1828–1834.  https://doi.org/10.1253/circj.CJ-15-0042 CrossRefPubMedGoogle Scholar
  18. 18.
    Nademanee K, Singh BN, Stevenson WG, Weiss JN (1993) Amiodarone and post-MI patients. Circulation 88:764–768CrossRefPubMedGoogle Scholar
  19. 19.
    Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E, Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC), Association for European Pediatric Cardiology (AEPC), ESC Committee for Practice Guidelines (CPG) (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31:2915–2957.  https://doi.org/10.1093/eurheartj/ehq249 CrossRefPubMedGoogle Scholar
  20. 20.
    Yamada Y, Shiga T, Matsuda N, Hagiwara N, Kasanuki H (2007) Incidence and predictors of pulmonary toxicity in Japanese patients receiving low-dose amiodarone. Circ J 71:1610–1616CrossRefPubMedGoogle Scholar
  21. 21.
    Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J (2015) Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 3:CD005049.  https://doi.org/10.1002/14651858.CD005049.pub4 CrossRefGoogle Scholar
  22. 22.
    Roy D, Talajic M, Dorian P, Connolly S, Eisenberg MJ, Green M, Kus T, Lambert J, Dubuc M, Gagné P, Nattel S, Thibault B (2000) Amiodarone to prevent recurrence of atrial fibrillation: Canadian trial of atrial fibrillation investigators. N Engl J Med 342:913–920.  https://doi.org/10.1056/NEJM200003303421302 CrossRefPubMedGoogle Scholar
  23. 23.
    Chun SH, Sager PT, Stevenson WG, Nademanee K, Middlekauff HR, Singh BN (1995) Long-term efficacy of amiodarone for the maintenance of normal sinus rhythm in patients with refractory atrial fibrillation or flutter. Am J Cardiol 76:47–50CrossRefPubMedGoogle Scholar
  24. 24.
    Gosselink AT, Crijns HJ, Van Gelder IC, Hillige H, Wiesfeld AC, Lie KI (1992) Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA 267:3289–3293CrossRefPubMedGoogle Scholar
  25. 25.
    Koyak Z, Kroon B, de Groot JR, Wagenaar LJ, van Dijk AP, Mulder BA, Van Gelder IC, Post MC, Mulder BJ, Bouma BJ (2013) Efficacy of anti-arrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias. Am J Cardiol 112:1461–1467.  https://doi.org/10.1016/j.amjcard.2013.07.029 CrossRefPubMedGoogle Scholar
  26. 26.
    Shiga T, Wakaumi M, Imai T, Suzuki T, Hosaka F, Yamada Y, Matsuda N, Shoda M, Sugiura R, Hagiwara N, Kasanuki H (2002) Effect of low-dose amiodarone on atrial fibrillation or flutter in Japanese patients with heart failure. Circ J 66:600–604CrossRefPubMedGoogle Scholar
  27. 27.
    Domanski MJ, Sakseena S, Epstein AE, Hallstrom AP, Brodsky MA, Kim S, Lancaster S, Schron E (1999) Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias: AVID Investigators. Antiarrhythmics Versus Implantable Defibrillators. J Am Coll Cardiol 34:1090–1095CrossRefPubMedGoogle Scholar
  28. 28.
    Shiga T, Wakaumi M, Matsuda N, Shoda M, Hagiwara N, Sato K, Kasanuki H (2001) Amiodarone-Induced thyroid dysfunction and ventricular tachyarrhythmias during long-term therapy in Japan. Jpn Circ J 65:958–960CrossRefPubMedGoogle Scholar
  29. 29.
    Dusman RE, Stanton MS, Miles WM, Klein LS, Zipes DP, Fineberg NS, Heger JJ (1990) Clinical features of amiodarone-induced pulmonary toxicity. Circulation 82:51–59CrossRefPubMedGoogle Scholar
  30. 30.
    Kudenchuk PJ, Pierson DJ, Greene HL, Graham EL, Sears GK, Trobaugh GB (1984) Prospective evaluation of amiodarone pulmonary toxicity. Chest 86:541–548CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric CardiologySakakibara Heart InstituteTokyoJapan
  2. 2.Department of PediatricsTohoku University Graduate School of MedicineSendaiJapan

Personalised recommendations