Is it safe to use visible blue light-emitting diode phototherapy for neonatal jaundice in infants who are also treated with amiodarone?

Amiodarone is a useful treatment for neonatal cardiac arrhythmias. A minority of neonates with arrhythmias treated with amiodarone may also develop neonatal jaundice. Phototherapy is recommended to treat neonatal jaundice. However, amiodarone is known to cause skin reactions when patients are exposed to light. Therefore phototherapy may not be administered due to concerns about this interaction. Exchange transfusions are used as an alternative to phototherapy to avoid the interaction. However, exchange transfusions are associated with serious complications such as the transmission of bloodborne disease, seizures and haemodynamic instability. We report a literature review and outcome of a premature infant treated with amiodarone and visible blue light-emitting diode (LED) phototherapy. Phototherapy was used for 54 hours and no skin reactions were observed. This is because visible blue LED phototherapy lamps emit predominantly visible light. Therefore exposure to ultraviolet light that is known to cause amiodarone phototoxicity is minimised.

AMIODARONE AND THYROID DYSFUNCTION.

Thyroid gland has a key role in maintaining the body homeostasis. Thyroxine is the main hormone secreted from the thyroid gland, its effect being predominantly achieved after the intracellular conversion of thyroxine to triiodothyronine, which exhibits a higher affinity for the receptor complex, thus modifying gene expression of the target cells. Amiodarone is one of the most commonly used antiarrhythmics in the treatment of a broad spectrum of arrhythmias, usually tachyarrhythmias. Amiodarone contains a large proportion of iodine, which is, in addition to the intrinsic effect of the medication, the basis of the impact on thyroid function. It is believed that 15%-20% of patients treated with amiodarone develop some form of thyroid dysfunction. Amiodarone may cause amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). AIT is usually developed in the areas with too low uptake of iodine, while AIH is developed in the areas where there is a sufficient iodine uptake. Type 1 AIT is more common among patients with an underlying thyroid pathology, such as nodular goiter or Graves' (Basedow's) disease, while type 2 mostly develops in a previously healthy thyroid. AIH is more common in patients with previously diagnosed Hashimoto's thyroiditis. Combined types of the diseases have also been described. Patients treated with amiodarone should be monitored regularly, including laboratory testing and clinical examinations, to early detect any deviations in the functioning of the thyroid gland. Supplementary levothyroxine therapy is the basis of AIH treatment. In such cases, amiodarone therapy quite often need not be discontinued. Type 1 AIT is treated with thyrostatic agents, like any other type of thyrotoxicosis. If possible, the underlying amiodarone therapy should be discontinued. In contrast to type 1 AIT, the basic pathophysiological substrate of which is the increased synthesis and release of thyroid hormones, the basis of type 2 AIT is destructive thyroiditis caused by amiodarone, desethylamiodarone as its main metabolite, and an increased iodine uptake. Glucocorticoid therapy is the basis of treatment for this type of disease.

Identification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody Tests.

Introduction: Serum thyrotropin (TSH) receptor antibodies (TRAbs) are occasionally found in patients with amiodarone-induced thyrotoxicosis (AIT), and usually point to a diagnosis of type 1 AIT (AIT1) due to Graves' disease (GD). However, the TRAb role and function in AIT have not been clarified. Methods: A retrospective cohort study of 309 AIT patients followed at a single academic center over a 30-year period. AIT TRAb-positive patients (n = 21, 7% of all cases) constituted the study group; control groups consisted of type 2 AIT (AIT2) TRAb-negative patients (n = 233), and 100 non-AIT patients with GD. Clinical and biochemical data at diagnosis and during the course of disease were compared. Histological samples of patients who had total thyroidectomy were reviewed. Stored serum samples were used for a functional assay of TRAb class G immunoglobulins (IgGs) in Chinese hamster ovary (CHO) cells stably transfected with complementary DNA encoding for the TSH receptor. Results: TRAb-positive patients were grouped according to color flow Doppler sonography, radioactive iodine thyroid uptake, and duration of amiodarone therapy before thyrotoxicosis in type 1 (n = 9, 43%; TRAb1) or type 2 (n = 12, 57%; TRAb2) AIT. TRAb1 patients had clinical and biochemical features indistinguishable from GD controls, and were responsive to methimazole. Conversely, TRAb2 patients had clinical features similar to AIT2 controls, and were responsive to glucocorticoids, but not to methimazole. The CHO cell functional assay demonstrated that TRAb1 IgGs had a stimulatory effect on cyclic AMP production, which was absent in TRAb2 IgGs. Pathology in TRAb1 showed hyperplastic thyroid follicles and mild lymphocyte infiltration, reflecting thyroid stimulation. On the contrary, TRAb2 samples revealed follicle destruction, macrophage infiltration, and sometimes fibrosis, consistent with a destructive process. Conclusions: Almost 60% of TRAb-positive AIT patients had a destructive thyroiditis. TRAb-positive tests in AIT patients do thus not necessarily imply a diagnosis of GD and AIT1, and should be evaluated in the clinical and biochemical setting of each AIT patient and confirmed by measuring thyroid-stimulating immunoglobulins.

Grape seed extract protects against amiodarone - induced nephrotoxicity and ultrastructural alterations associated with the inhibition of biomarkers of inflammation and oxidative stress in rats.

Amiodarone (AMD) is one of the highly effective antiarrhythmic agents used for treating refractory arrhythmias. It is well known to have long-term administration side effects such as nephrotoxicity. The possible ameliorative effects of antioxidant grape seed extract; on the extent of tissue damage in AMD-induced nephrotoxicity has not been investigated before. Twenty-four albino rats were used in this study and divided into four groups (n = 6). The 1st group served as an untreated control group, under the same laboratory conditions, the 2nd group received (100 mg/kg/day) of grape seed extract (GSE), the 3rd group, AMD-treated group, received AMD (40 mg/kg/day) and the 4th group received both AMD and GSE in the same doses as the previous groups. AMD-treated group showed abnormal glomerular capillaries with wrinkling basement membranes damaged mesangial cells and distorted proximal tubules with plenty of lysosomes. Ultrastructural alterations were also observed in this group. This was also associated with a significant increase in biomarkers of kidney injury (creatinine), oxidative stress ((Decreased SOD and increased MDA) and biomarkers of inflammation IL-6) in comparison to the control group. Supplementation of GSE to AMD group for eight weeks counteracted these effects. It caused an improvement in histological and t ultrastructure changes of the renal tissues associated with decreased creatinine and biomarkers of oxidative stress and inflammation in comparison to AMD-treated group. We conclude that GSE protects against AMD-induced kidney injuries in rats, which is associated with the inhibition of biomarkers of inflammation and oxidative stress.

Congenital Heart Disease and Thyroid Dysfunction: Combination, Association, and Implication.

BACKGROUND: Patients with congenital heart disease have higher prevalence of thyroid dysfunction due to embryonic and genetic coexistence. Marked changes in cardiac function occur secondary to alternations in thyroid hormone levels. Cardiac catheterizations or cardiac surgeries with cardiopulmonary bypass can cause abnormalities in the circulating hormones, in the absence of primary thyroid disease. Therefore, monitoring of thyroid function should be routinely performed in children with congenital heart disease. Thyroid hormone supplementation has been postulated as a possible therapeutic option; however, the therapeutic decisions should be made based on individual circumstances, symptoms, and the severity of the thyroid dysfunction. OBJECTIVES: To describe the correlation between congenital heart disease in children and thyroid dysfunction and the debate on monitoring, intervention, and treatment. METHODS: PubMed, Clinical Key, and the Cochrane Library were searched using keywords relevant to congenital heart disease/surgery, cardiopulmonary bypass, thyroid hormones, sick euthyroid syndrome, and cardiac catheterization. Studies were limited to the English language and to children 0 to 18 years old. Studies in adults with important findings were reviewed as well. All clinical studies believed to have relevance were considered. All relevant studies were reviewed, and the most pertinent data were incorporated in this review. CONCLUSION: There is lack of significant evidence concerning treatment for thyroid dysfunction in children with a congenital cardiac diagnosis. Adequately powered studies are needed before a uniform recommendation about treatment can be made.

Effect of acupuncture at Neiguan point combined with amiodarone therapy on early recurrence after pulmonary vein electrical isolation in patients with persistent atrial fibrillation.

OBJECTIVE: Early atrial fibrillation (AF) recurrences are common and have been shown to predict AF recurrences late after AF ablation during follow-up. Neiguan point acupuncture has been recognized to be therapeutic in treating AF in clinical practice. METHODS AND RESULTS: Eighty-five patients were enrolled in succession due to persistent AF. All patients were randomized divided into control group and acupuncture group. In the control group (n = 45), amiodarone was orally taken from the first day after pulmonary vein isolation (PVI). In the acupuncture group (n = 40), patients were treated with Neiguan point acupuncture for 7 days and amiodarone was prescribed as same as the control group after PVI. The levels of inflammatory factors were analyzed before operation, 1 week after the operation and 3 months later. After 3 months, the acupuncture group had a lower rate of early recurrences than the control group (5/40 [12.5%] vs 15/45 [33.3%], P = 0.039). The inflammatory factors level in the two groups were significantly increased after ablation. However, compared with the control group, the levels of TNF-α, IL-6, CRP, TGF-ß1, MMP2 in the acupuncture group significantly lower (P < 0.05). In a multivariate analysis, acupuncture was an independent factor associated with a lower rate of early recurrences during the blanking period (odds ratio, 0.17; 95% confidence interval, 0.05-0.63; P = 0.008). CONCLUSION: Neiguan point acupuncture combined with amiodarone is superior to amiodarone alone in reducing early recurrences of patients with persistent AF after PVI. The efficacy of Neiguan acupuncture therapy on the early recurrence is associated with the decreased inflammation factors.

Amiodarone and acupuncture for cardiac arrhythmia: Study protocol for a systematic review.

BACKGROUND: Amiodarone and acupuncture (AA) are commonly used to treat cardiac arrhythmia (CA). The objective of this systematic review is to assess the efficacy and safety of AA for patients with CA. METHODS: Randomized controlled trials (RCTs) of AA for CC will be searched from 9 databases including PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from inception to February 1, 2019 without any limitations. Two reviewers will independently screen the relevant papers, extract data, and evaluate the risk of bias for each included study. RevMan 5.3 software will be used for meta-analysis. The primary outcome includes arrhythmic episodes (including time and frequency domain parameters). The secondary outcomes consist of health-related quality of life, oxygen saturation, and safety. RESULTS: The protocol of this proposed study will provide evidence to judge whether AA is an effective treatment for patients with CA. CONCLUSION: The findings of this proposed study will summarize the up-to-date evidence of AA for CA. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019120962.

Effect of excess iodine intake on thyroid on human health.

The recommended daily intake of iodide, is 150 µg for adolescents and adults, 250 µg for pregnancy and lactation. Thyroid gland is an effective collector of iodine. The active iodine uptake along the basolateral membrane of thyroid cell is followed by its transport to the apical edge of the cell and then to the follicle lumen. TSH acts through cAMP and stimulates NIS gene expression and protein synthesis. The major proportion of iodine in the thyroid gland is bound to Thyroglobulin. The non-organic intrathyroidal iodine is usually low, but significantly greater compared to plasma. Large doses of iodine reduce both the uptake and the organification (Wolff-Chaikoff effect) and cause partial inhibition of Tg proteolysis. The thyroid gland has several protective mechanisms resulting on the maintenance of normal thyroid function despite wide fluctuations of the daily iodine intake. Ingestion of several commonly used drugs and food conservatives results in acute or chronic excessive iodine intake. Failure to escape from the iodine induced organification inhibition can cause hypothyroidism, which is temporary and subsides after iodine exposure ceases. Iodine excess may also establish a status of excessive thyroid hormone synthesis and release, thus inducing autonomic thyroid function in iodopenic areas or can contribute to the development of iodine-induced hyperthyroidism in iodine abundant areas. The anti-arrhythmic Amiodarone, is a benzofuranic product with a very high iodine content, is associated with either hypo- or hyperthyroidism development. In the presence of defective auto-protective mechanisms, excessive iodine ingestion can divert the normal thyroid function.

Safety and efficacy of early radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation complicated with amiodarone-induced thyrotoxicosis.

BACKGROUND: Amiodarone is an antiarrhythmic drug that is frequently used to control atrial fibrillation (AF). Many patients with AF are afraid of the risk of ablation and take amiodar-one, some patients develop amiodarone-induced thyrotoxicosis (AIT). The purpose of the study was to investigate the safety and efficacy of early radiofrequency catheter ablation in patients with paroxysmal AF complicated with AIT. METHODS: From the 146 consecutive patients with paroxysmal AF who had been treated with amiodarone and underwent 3-dimensional mapping system guided circumferential pulmonary vein isolation (PVI) at our center from January 2013 to June 2014, 20 had developed AIT. Thirty controls with normal thyroid function and matched for baseline characteristics were selected. RESULTS: Pulmonary vein isolation was completed in all patients without serious complications and with similar procedural (170.60 ± 14.80 vs. 158.18 ± 9.06 min; p = 0.062) and X-ray exposure (16.48 ± 2.15 vs. 15.36 ± 1.57 min; p = 0.058) time in AIT vs. control groups; however, upon coronary sinus catheter pacing (from 300 ms to 200 ms) after intrave-nous isoproterenol administration 30 min post PVI, rates of induction of AF (35% vs. 3.33%; p = 0.005) and of non-pulmonary vein-related atrial tachyarrhythmias (50% vs. 6.67%; p = 0.01) were higher, while those for atrial flutter (15% vs. 3.33%; p = 0.17) and atrial tachycardia (15% vs. 6.67%; p = 0.31) were similar, as was the recovery of conduction of pulmonary vein potential (15% vs. 30%; p = 0.191). In AIT vs. control group, atrial tachyarrhythmia recurrence rate was higher at 3 months (45% vs. 16.67%, p = 0.032) but not between 3 and 12 months (30% vs. 23.33%; p = 0.418) follow-up. CONCLUSIONS: Early catheter ablation for paroxysmal AF in patients with AIT appeared safe and effective albeit with higher atrial tachyarrhythmia recurrence rate up to 3 months but not beyond 12 months after PVI relative to controls.

Pathological autopsy of a patient that underwent a successful ablation of an electrical storm from the left ventricular summit.

A 65-year-old man with non-ischemic cardiomyopathy, underwent an autopsy 2 months after the successful ablation of a sustained left ventricular (LV) summit ventricular tachycardia (VT). The patient died due to interstitial pneumonia from amiodarone use. The earliest activation sites of the VT were documented from both inside the anterior interventricular vein (AIV) and epicardial surface. The diameter of the AIV was 3-4 mm, and the radiofrequency (RF) lesion inside the AIV was a slight lesion due to high impedance with a high temperature. The lesion from the epicardial surface was also superficial and insufficient due to neighboring coronary arteries and the existence of epicardial fat. A successful application was performed from the LV endocardium, and diffuse myocardial fibrosis was observed in the mid-myocardium including inside the RF lesions. The actual relationship between the myocardial fibrosis and LV summit VT remains unclear, but this case showed the difficulty of achieving a successful ablation from the epicardial side, when the focus exists in the mid-myocardium around the LV summit.

Iodine-induced hyperthyroidism as combination of different etiologies: an overlooked entity in the elderly.

Iodine-induced thyrotoxicosis, which raises several diagnostic and therapeutical challenges, is often overlooked. Hyperthyroidism can induce atrial fibrillation, a harmful arrhythmia which can precipitate heart failure and cause stroke. We report the case of an elderly man who was diagnosed with tachyfibrillation secondary to hyperthyroidism. Thyroid hyperfunction was subsequently related both to previous amiodarone therapy (probably mixed form) and the recent use of iodinated contrast medium for computed tomography scan. Thyroid ultrasonography showed a plongeant multinodular goitre. After initial worsening, thyroid function improved slowly but progressively on high-dose thyreostatic therapy combined with steroid therapy; tachyfibrillation caused heart failure and a thrombus in the left atrium, and proved initially resistant to combined antiarrhythmic treatments. Progressive reduction in thyroid hormone levels, together with combined cardiologic therapies, controlled the heart rate, though atrial fibrillation persisted; anticoagulant therapy resolved the atrial thrombus. Alterations in thyroid function are common in amiodarone-treated patients, who therefore require regular hormonal checks. The different forms of amiodarone-induced thyrotoxicosis must be investigated, since they require different therapies, though mixed forms often occur. The superimposition of further iodine excess due to other causes may be catastrophic and cause severe cardiac problems in these patients.

[Hemoptysis during concomitant treatment with rivaroxaban and amiodarone in a patient with a history of pulmonary disease]. / Krwioplucie w trakcie jednoczesnego leczenia rywaroksabanem i amiodaronem u chorego z obciazonym wywiadem plucnym.

UNLABELLED: Rivaroxaban, a selective inhibitor of active factor X, is metabolized by cytochrom P450 3A4 (CYP3A4) and is a substrate for transporter protein--P-glycoprotein (P-gp). Amiodarone, an antiarrhytmic agent, is classified as moderate CYP3A4 and P-gp inhibitor. A CASE REPORT: A 75-year-old male, who underwent lobectomy for bronchiectasis many years ago, is presented. For one year the patient was treated with rivaroxaban (20 mg/d) due to venous thromboembolism and recurrent episodes of atrial fibrillation. Two weeks after amiodarone initiation (200 mg/d) hemoptysis occurred and computed tomography revealed unilateral pulmonary infiltrates with ground-glass opacities limited to the lower lobe of the left lung. The symptoms disappeared following discontinuation of the two medications and did not recur while rivaroxaban was reintroduced in a dose of 15 mg/d; measurement of anti-Xa activity confirmed it as a therapeutic dose. Amiodarone, that had been used for a short time and well tolerated a few years before, was definitely withdrawn. CONCLUSIONS: The authors suggest, that the concomitant use of rivaroxaban and amiodarone should be very careful in patients with a history of pulmonary disease.

Amiodarone-Associated Optic Neuropathy: A Nationwide Study.

PURPOSE: To investigate whether amiodarone use is associated with an increased risk of optic neuropathy. DESIGN: Retrospective population-based cohort study. PARTICIPANTS: Patients newly treated with amiodarone between 2005 and 2009 were identified from the Taiwan National Health Insurance Research Database. For each case patient, the study also included 4 age- and gender-matched control subjects who did not receive amiodarone treatment. METHODS: Cox multivariate regression analysis was used to assess the association between amiodarone and the occurrence of optic neuropathy. MAIN OUTCOME MEASURES: Hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The analysis included 6175 amiodarone-treated patients and 24 700 controls. The mean age was 66.7 years and 55.3% of subjects were male. The mean follow-up was 688 days. During the observational period, optic neuropathy developed in 17 amiodarone-treated patients (0.3%) and 30 control patients (0.1%; P = 0.006). Multivariate Cox regression analysis showed that amiodarone-treated patients had a 2-fold increased risk of optic neuropathy (HR, 2.09; 95% CI, 1.13-3.85; P = 0.02). After stratification by gender, amiodarone use remained a significant factor for optic neuropathy development among male subjects (HR, 3.05; 95% CI, 1.42-6.55; P = 0.004), but not among female subjects (HR, 1.15; 95% CI, 0.38-3.47; P = 0.81). Among amiodarone-treated patients, male gender was associated with a nearly 3-fold increased risk of optic neuropathy development compared with female gender (HR, 2.91; 95% CI, 0.94-9.01; P = 0.06). We also detected a trend of increased cumulative incidence of optic neuropathy with longer treatment duration (>41 vs. ≤41 days; HR, 3.46; 95% CI, 0.99-12.07; P = 0.05). However, higher daily dose did not increase the risk of optic neuropathy (HR, 0.96; 95% CI, 0.91-1.00; P = 0.07). CONCLUSIONS: These results demonstrated a higher risk of optic neuropathy in patients treated with amiodarone, especially in males and possibly in patients with longer duration of treatment.

Drug-induced hepatic steatosis.

Several drugs have been associated with the potential for drug-induced hepatic steatosis (DIHS) and/or phospholipidosis (DIPL), a lysosomal storage disorder. Drug-induced hepatic steatosis is generally a chronic but reversible affliction and may involve drug accumulation in the liver. Fat accumulation may be either macrovesicular or microvesicular in nature. Commonly used medications associated with DIHS include amiodarone, valproate, tamoxifen, methotrexate, and some chemotherapeutic and antiretroviral agents. Two recently approved medications for the treatment of hereditary homozygous hypercholesterolemia have also been noted to cause hepatic steatosis. For some compounds such as methotrexate and tamoxifen, the underlying metabolic risk factors such as obesity and metabolic syndrome may exacerbate their potential to cause DIHS and its progression. In this article, the authors discuss the preclinical screening and mechanisms of DIHS and DIPL, and review specific examples of drugs commonly used in clinical practice that are known to cause DIHS.

Hipertiroidismo no controlado inducido por amiodarona: implicaciones anestésicas / Uncontrolled hypertyroidism amiodarone-induced: anesthetic implications

La amiodarona es un fármaco antiarrítmico de clase III utilizado en el manejo urgente de la fibrilación auricular (FA) y taquicardia ventricular sostenida y en el tratamiento crónico de la FA y taquicardias paroxísticas supraventriculares. Por su alto contenido en iodo, puede ocasionar trastornos en la función tiroidea hasta en el 20 % de los pacientes que la toman, siendo la incidencia de hipertiroidismo inducido por amiodarona (HIA) del 2 al 10 %.El hipertiroidismo no controlado puede conllevar en los casos de crisis tirotóxica o tormenta tiroidea (TT) una mortalidad del 20 al 60 % según las series. La incidencia de TT intraoperatoria ha disminuido en los últimos tiempos gracias a la adopción de medidas de optimización preoperatoria encaminadas a disminuir los niveles de hormonas tiroideas circulantes. Presentamos el caso de una paciente con un hipertiroidismo no controlado secundario a amiodarona, propuesta para osteosíntesis tras fractura subtrocantérea femoral derecha. Repasamos las principales consideraciones anestésicas que requiere el manejo de un paciente con HIA, incidiendo en la importancia de una exhaustiva valoración preoperatoria y en los beneficios que aporta la elección de una adecuada técnica anestésica en el control intraoperatorio y postoperatorio inmediato de los episodios de crisis tirotóxica. Describimos el empleo de una técnica intradural complementada con un bloqueo nervioso periférico, como una alternativa válida a la anestesia general (AU)

Amiodarone is a class III antiarrhythmic agent used in the emergency management of atrial fibrillation (AF), sustained ventricular tachycardia and chronic treatment of AF and paroxysmal supraventricular tachycardia. Because of its high iodine content, it may cause disturbances in thyroid function in up to 20 % of patients who take it, with an incidence of amiodarone-induced hyperthyroidism (AIH) from 2 to 10 %.Uncontrolled hyperthyroidism can generate in cases of thyrotoxic crisis or thyroid storm a mortality of 20 to 60 % depending on the series. The incidence of intraoperative thyroid storm has decreased in recent years thanks to the adoption of measures which reduce the levels of circulating thyroid hormones. We report the case of a patient with uncontrolled hyperthyroidism secondary to amiodarone, given right femoral osteosynthesis surgery after subtrochanteric fracture. We review the main anesthetic considerations requiring the management of a patient with AIH, highlighting the importance of a thorough preoperative assessment and the benefits of choosing a suitable anesthetic technique on intraoperative and immediate postoperative episodes of thyroid storm. We describe the use of a spinal technique supplemented by a peripheral nerve block, as a valid alternative to general anesthesia (AU)

Amiodarone reduces the amount of ablation during catheter ablation for persistent atrial fibrillation.

AIMS: The step-wise approach to catheter ablation for persistent atrial fibrillation (AF) requires considerable substrate modification targeting at complex fractionated atrial electrograms (CFAEs) in addition to pulmonary vein (PV) isolation. An alternative strategy that minimizes the amount of ablation would be desirable. The aim of this study was to investigate whether the use of pre-procedural amiodarone affects: (i) the amount of ablation required to achieve procedural success, and (ii) long-term outcomes. METHODS AND RESULTS: We studied 121 consecutive patients with persistent AF who underwent catheter ablation. The patients were divided into two groups: Group 1, amiodarone (n = 31); Group 2, other antiarrhythmic drugs or rate control (n = 90). All the patients underwent a step-wise ablation procedure beginning with PV isolation, then proceeding with ablation of the CFAEs and linear lesions until sinus rhythm was achieved. Mean left atrial cycle length of AF (AFCL) was recorded at each step. The number of CFAE ablation sites was recorded. The number of CFAE sites in Group 1 was significantly less than that in Group 2 (P = 0.0121). The AFCLs after each step in Group 1 were significantly longer than those in Group 2. The procedure time and the radiofrequency time of CFAE ablation in Group 1 were significantly shorter than that in Group 2 (P = 0.0276 and P = 0.0458, respectively). There was no significant difference between the two groups in early and long-term outcomes. CONCLUSION: Use of pre-procedural amiodarone prolongs AFCL during catheter ablation and reduces the number of CFAE sites requiring ablation to achieve procedural success while maintaining equivalent long-term results.

Protective effects of neferine on amiodarone-induced pulmonary fibrosis in mice.

The effects of neferine, a bisbenzylisoquinline alkaloid extracted from the Chinese traditional medicine seed embryo of Nelumbo nucifera Gaertn, on amiodarone-induced pulmonary fibrosis in mice were evaluated. Adult Kunming mice were induced to develop pulmonary fibrosis through intratracheal instillation of amiodarone (6.25 mg/kg) on the 1st, 3rd and 5th day. Mice were treated orally with saline, neferine (20 mg/kg), prednisolone (15 mg/kg), pirfenidone (100 mg/kg) twice a day after the third amiodarone instillation. On Day 21, all the lung tissues were collected for hydroxyproline measurement and the histological examination by hematoxylin-eosin and Masson staining. All the blood sample were collected for surfactant protein-D (SP-D) levels assay, Th1/Th2 balance valuation, CD4+CD25+ regulatory T cells (Tregs) analysis by Enzyme-linked immunosorbent assay and flow cytometry. Our data showed that neferine significantly restored the significant reductions in body weights, the increased levels of lung index and hydroxyproline, the abnormal histological findings, the serum SP-D increase, the Th1/Th2 imbalance by decreasing IL-4 and increasing IFN-γ levels and the increases in the population of CD4+CD25+ Tregs associated with amiodarone instillation in mice. Similar changes were also observed in the prednisolone or pirfenidone treated mice. In conclusion, these results indicated that neferine possessed a significant inhibitory effect on amiodarone-induced pulmonary fibrosis, probably due to its properties of anti-inflammation, SP-D inhibition and restoring increased CD4+CD25+ Tregs which may modulate Th1/Th2 imbalance by suppressing Th2 response (from Th2 polarity toward a Th1 dominant response).

Catheter ablation of paroxysmal atrial fibrillation in patients with previous amiodarone-induced hyperthyroidism: a case-control study.

INTRODUCTION: Many patients with atrial fibrillation (AF) receive amiodarone. Amiodarone-induced hyperthyroidism (AIH) may develop as a complication. We hypothesized that pulmonary vein (PV) isolation in patients with paroxysmal AF and history of AIH may yield a lower success rate. METHODS AND RESULTS: Among 704 patients who underwent AF ablation in our center between 2007 and 2010, we identified 20 patients (mean age 58.3 ± 5.0 years; 11 males) with paroxysmal AF and overt AIH in the past. The control group consisted of 40 patients with amiodarone-refractory AF and no thyroid dysfunction. All patients underwent circumferential PV isolation. During redo procedures all tachycardias were targeted for ablation. During a 12-month follow-up, in the AIH group 6 (30%) patients were arrhythmia free after a single procedure, in comparison to 25 (62.5%) controls (P = 0.01). Atrial tachycardia (AT) was registered in 7 (35%) AIH patients and in 1 (2.5%) control patient (P = 0.001). AF recurred in 10 (50%) AIH versus 15 (37.5%) control patients (P = 0.2). Redo ablation was performed in 7 (35%) AIH patients and in 3 (7.5%) non-AIH patients (P = 0.01). During a redo procedure a PV-unrelated tachycardia was diagnosed in 5 (25%) AIH patients (vs 0 in the controls, P = 0.003). After the last performed ablation, 12 (60%) AIH patients and 28 (70%) controls had no recurrence, P = 0.56. AIH was an independent predictor of ATs. CONCLUSION: PV isolation alone has a lower efficacy for preventing recurrence in paroxysmal AF in AIH patients. After repeat ablations, overall freedom from tachyarrhythmias is similar to patients with no history of thyroid dysfunction.

Extensive antiarrhythmic drugs after catheter ablation of persistent atrial fibrillation.

OBJECTIVE: Whether early rhythm suppression with extensive antiarrhythmic drugs (AADs) in persistent atrial fibrillation (AF) after catheter ablation decreases arrhythmia recurrence is unknown. We now report the 12-month follow-up data in this prospective and randomized study. METHODS AND RESULTS: 123 consecutive patients with persistent AF undergoing catheter ablation were randomly divided into an extensive AADs therapy group (group 1:62 patients using both class Ic and III AADs) or one AAD therapy group (group 2:61 patients using class Ic or III AADs alone) for the initial 2 months after ablation. Recurrence of atrial tachyarrhythmias (ATa) was valuated at both 2 months and 12 months following ablation. During the first 2 months after ablation, less ATa were found in group 1 compared with group 2 (17/62 versus 29/61, P = 0.021). However, there was no difference with regard to ATa at 12 months between the groups (21/62 versus 22/61, P = 0.799). ATa at 2 months and left atrial diameter (LAD) were the statistically significant predictors of ATa during 12-month follow-up. CONCLUSIONS: While use of extensive AADs within the initial 2 months after persistent AF ablation decreases early ATa, it does not prevent late ATa. Moreover, LAD as well as early ATa is a strong predictor of ATa at 12 months.