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1.
Med. intensiva (Madr., Ed. impr.) ; 43(8): 457-463, nov. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-185882

RESUMO

Objectives: Although amiodarone may cause neurotoxicity that can affect patient outcomes when used during cardiopulmonary resuscitation (CPR), it has been commonly prescribed during CPR. This study investigated the possible neurotoxic effects of amiodarone in a rat model of transient forebrain ischemia. Design: A prospective laboratory animal study was carried out. Setting: Animal laboratory. Materials: Male Sprague-Dawley rats. Intervention: Eight minutes of forebrain ischemia was induced in rats by bilateral carotid occlusion and hypotension (mean arterial pressure=35mmHg) under isoflurane (1.5%) anesthesia. Amiodarone (0, 50, 100 and 150mg/kg) with saline was injected intraperitoneally 10min after ischemia. Rats given 0mg/kg of amiodarone were used as saline-treated controls. Sham operated rats received no treatment. Variables of interest: Animals were evaluated neurologically on postoperative days 4-7, and histologically after a one-week recovery period. Results: The greatest improvement in water maze test performance corresponded to the sham operated group (p=0.015 vs. saline-treated controls). No differences in performance were seen in amiodarone-treated rats compared with saline-treated controls. In the control group, 45% of the CA1 hippocampal neurons survived, compared with 78% in the sham operated group (p=0.009). Neuron survival after ischemia in the amiodarone treatment groups (50, 100 and 150mg/kg) (58%, 40% and 36%, respectively) and in the control rats did not differ significantly. Conclusions: The administration of amiodarone immediately after transient forebrain ischemia did not worsen spatial cognitive function or neuronal survival in the hippocampal CA1 region in rats. The current results must be applied with caution in humans. However, they indicate that the potential neurotoxicity induced by amiodarone during resuscitation after cardiac arrest may be negligible


Objetivos: La amiodarona puede causar neurotoxicidad que afecte a los desenlaces de los pacientes si se usa durante la reanimación cardiopulmonar (RCP), si bien este fármaco se ha prescrito habitualmente a pacientes durante la RCP. Este estudio ha investigado los posibles efectos neurotóxicos de la amiodarona en un modelo de isquemia transitoria del prosencéfalo en ratas. Diseño: Estudio prospectivo con animales de laboratorio. Ámbito: Laboratorio de animales. Materiales: Ratas Sprague-Dawley macho. Intervención: Se produjo isquemia del prosencéfalo en ratas durante ocho minutos mediante oclusión bilateral de la carótida e hipotensión (mediana de la presión arterial=35 mmHg) bajo anestesia con isoflurano (1,5%). Se inyectó intraperitonealmente amiodarona (0, 50, 100, 150 mg/kg) con solución salina 10 minutos después de la isquemia. Se administraron 0 mg/kg de amiodarona a las ratas empleadas como controles tratados con solución salina. No se administró ningún producto a las ratas del grupo quirúrgico de referencia. Variables de interés: Los animales fueron evaluados neurológicamente durante los días 4-7 tras la intervención, e histológicamente tras un período de recuperación de una semana. Resultados: La mayor mejora del rendimiento en la prueba del laberinto acuático se observó en el grupo quirúrgico de referencia (p=0,015 frente a los controles tratados con solución salina). No se observaron diferencias en el rendimiento de las ratas tratadas con amiodarona respecto a los controles que recibieron solución salina. En el grupo control sobrevivió el 45% de las neuronas del hipocampo CA1, frente al 78% en el grupo quirúrgico de referencia (p=0,009). No se observaron diferencias significativas en cuanto a la supervivencia neuronal tras la isquemia entre los grupos tratados con amiodarona (50, 100 y 150 mg/kg, 58, 40 y 36% respectivamente) y las ratas del grupo control. Conclusiones: La administración de amiodarona inmediatamente después de la isquemia transitoria del prosencéfalo no empeoró la función cognitiva espacial ni la supervivencia neuronal en la región del hipocampo CA1 en ratas. Se debe tener precaución al aplicar los resultados actuales a los humanos. Sin embargo, dichos resultados señalan que la posible neurotoxicidad inducida por la amiodarona durante la reanimación tras parada cardíaca puede ser insignificante


Assuntos
Animais , Ratos , Masculino , Amiodarona/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/veterinária , Prosencéfalo/efeitos dos fármacos , Estudos Prospectivos , Ratos Sprague-Dawley , Injeções Intraperitoneais/veterinária
2.
J Vet Diagn Invest ; 31(5): 742-746, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378166

RESUMO

To date, there is no clear standard to monitor drug treatment for canine Chagas disease. We used 2 real-time PCR (rtPCR) assays targeting Trypanosoma cruzi kinetoplast DNA (kDNA) and nuclear satellite DNA (nDNA) to detect T. cruzi in canine whole blood. Samples were collected randomly from 131 untreated dogs with unknown T. cruzi infection status in Texas. The kDNA-based rtPCR was slightly more sensitive (diagnostic sensitivity of kDNA = 49% vs. nDNA = 44%; p = 0.5732) but slightly less specific (diagnostic specificity of kDNA = 96% vs. nDNA = 97%; p > 0.9999) than the nDNA-based rtPCR. However, the differences in sensitivity and specificity between the nDNA- and kDNA-based rtPCR assays were not statistically significant. Using the nDNA- and kDNA-based qualitative rtPCR assays to monitor parasitemia from 137 itraconazole- and amiodarone-treated cases with nDNA- and kDNA-based PCR-positive baselines showed that the PCR positive rate decreased to 0% in 30 d. Using kDNA-based quantitative rtPCR to monitor normalized T. cruzi DNA copies in 4 representative dogs demonstrated that drug treatment could reduce parasite loads within 7-30 d. The kDNA-based qualitative rtPCR may be used for routine parasitemia screening of drug-treated Chagas-positive dogs, whereas nDNA-based qualitative rtPCR may be used for confirmation.


Assuntos
Doença de Chagas/prevenção & controle , DNA de Protozoário/sangue , Doenças do Cão/prevenção & controle , Parasitemia/tratamento farmacológico , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/isolamento & purificação , Amiodarona/uso terapêutico , Animais , DNA de Cinetoplasto/sangue , DNA Satélite/sangue , Cães , Itraconazol/uso terapêutico , Parasitemia/parasitologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade , Texas
3.
Exp Parasitol ; 205: 107747, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442454

RESUMO

Development of new chemotherapeutic agents is an essential issue in the treatment and control of a disease. This study aimed to evaluate the anti-leishmanial activity of amiodarone, an antiarrhythmic class III drug, against Leishmania major, the most prevalent etiological agent of cutaneous leishmaniasis in the old world. The proliferation of promastigotes and intracellular amastigotes in the absence or presence of amiodarone was estimated, in an in vitro study. For in vivo study, five weeks after infection of BALB/c mice with L. major, when the lesions appeared at the injection site, the mice were divided into four groups (n = 6 each); treatment was conducted for 28 consecutive days with vehicle, amiodarone at 40 mg/kg orally and glucantime at 60 mg/kg intraperitoneally. Therapy with amiodarone reduced the size of lesions compared to the untreated group after 12 days. Amiodarone decreased the parasite load and inflammatory responses, particularly the macrophages containing amastigotes, and enhanced granulation tissue formation in the dermis and subcutaneous area. The Tumor necrosis factor-α and Interleukin-6 levels were significantly lower in the cell culture supernatants of the inguinal lymph node in the amiodarone treated group compared to the vehicle and untreated groups. Amiodarone significantly increased the activity of glutathione peroxidase in comparison to the vehicle and untreated groups but did not affect the plasma levels of superoxide dismutase, malondialdehyde, adiponectin, and ferric reducing ability of plasma. Therefore, the anti- L. major activity and immunomodulatory effects of amiodarone reduced the parasitic load and enhanced wound healing in cutaneous leishmaniasis in BALB/c mice. Amiodarone reduced the lesion surface area, but it did not cure it completely.


Assuntos
Amiodarona/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmania major/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Adiponectina/sangue , Amiodarona/farmacologia , Animais , Antiarrítmicos/farmacologia , Antiarrítmicos/uso terapêutico , Antiprotozoários/farmacologia , Linhagem Celular , Feminino , Glutationa Peroxidase/metabolismo , Concentração Inibidora 50 , Interleucina-6/análise , Leishmania major/ultraestrutura , Leishmaniose Cutânea/parasitologia , Linfonodos/química , Linfonodos/imunologia , Macrófagos/parasitologia , Malondialdeído/sangue , Antimoniato de Meglumina/farmacologia , Antimoniato de Meglumina/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Carga Parasitária , Distribuição Aleatória , Pele/parasitologia , Pele/patologia , Pele/ultraestrutura , Superóxido Dismutase/metabolismo , Fator de Necrose Tumoral alfa/análise
4.
AACN Adv Crit Care ; 30(3): 249-258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462521

RESUMO

Postoperative atrial fibrillation is the most common dysrhythmia to occur after coronary artery bypass graft surgery. It develops in 10% to 40% of patients and can lead to complications such as hemodynamic instability, heart failure, and stroke. Risk factors include hypertension, diabetes, chronic kidney disease, and obesity. Patients who experience postoperative atrial fibrillation often have longer hospital stays, are at higher risk for readmission, and have increased mortality. Protocols designed to reduce the incidence of the condition can decrease hospital costs, improve patient outcomes, and increase overall quality of care. This quality improvement project took place in a tertiary care center located in southeastern Michigan and focused on the development and implementation of an evidence-based postoperative atrial fibrillation prophylaxis protocol using amiodarone. The outcomes of this project suggest that amiodarone prophylaxis can reduce the incidence of postoperative atrial fibrillation in patients with no previous history of atrial fibrillation undergoing coronary artery bypass graft surgery.


Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/enfermagem , Ponte de Artéria Coronária/efeitos adversos , Enfermagem de Cuidados Críticos/normas , Assistência Perioperatória/normas , Complicações Pós-Operatórias/prevenção & controle , Administração Oral , Fatores Etários , Idoso , Fibrilação Atrial/etiologia , Feminino , Humanos , Incidência , Masculino , Michigan , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Fatores de Risco
5.
Int J Mol Sci ; 20(16)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31443312

RESUMO

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver. In basic studies, the regulation of autophagy has offered promising results for HCC treatment. This study aimed to address the question of whether amiodarone can improve survival rates in HCC patients associated with autophagy. Using datasets from the National Health Insurance Research Database, we enrolled patients over 18 years of age that had been diagnosed with HCC between January 1997 and December 2010. Amiodarone and non-amiodarone users were matched at a 1:1 frequency, according to all variables. Additionally, HepG2 cells treated with amiodarone were evaluated by cell viability and autophagic change. Autophagic signaling was examined by immunoblotting and tissue array immunohistochemistry. Of the 10,946 patients diagnosed with HCC, each cohort included 221 patients after 1:1 propensity score matching. The median survival was 36.70 months for the amiodarone users, and 24.48 months for the non-amiodarone users. After adjusting for age, gender, comorbidities and treatment, amiodarone users had a significantly lower risk of mortality. Amiodarone users also demonstrated an improved 3-year survival rate. Furthermore, amiodarone treatment-induced autophagy in HepG2 cells was demonstrated by autophagosome formation associated with increasing LC3B-II, P62, and Beclin-1 expression. Autophagic flux also increased following amiodarone treatment with bafilomycin A1. SiRNA of LC3B knocked down endogenous LC3B formation and restored HepG2 cell viability. This study provides epidemiologic evidence that amiodarone via autophagic degradation machinery may offer survival benefits for HCC patients with a history of arrhythmia. Further randomized, blinded, and placebo-controlled trials are warranted for patients with HCC.


Assuntos
Amiodarona/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Idoso , Arritmias Cardíacas/tratamento farmacológico , Autofagia/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Feminino , Células Hep G2 , Humanos , Imuno-Histoquímica , Masculino , Modelos de Riscos Proporcionais , Transdução de Sinais/efeitos dos fármacos
6.
Medicine (Baltimore) ; 98(23): e15892, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169698

RESUMO

RATIONALE: Atrial fibrillation (AF) is a common arrhythmia disease that can cause thromboembolic disease and/or heart failure, resulting in increased mortality. Propafenone, amiodarone, and flecainide are recommended for converting AF to sinus rhythm. Beta blockers, verapamil, diltiazem, and digoxin are recommended for controlling AF with fast ventricular rate (VR). In this case report, we found that verapamil successfully converted AF into sinus rhythm. PATIENT CONCERNS: A 92-year-old woman presented with fast VR AF with a history of coronary heart disease, hypertension, and diabetes. DIAGNOSES: Verapamil can successfully convert AF into sinus rhythm. INTERVENTIONS AND OUTCOMES: The patient was treated with amiodarone or propafenone, yet still had AF. After stopping amiodarone and propafenone, the patient was given verapamil to control the VR, and following 9 days of treatment the patient switched to sinus rhythm. When verapamil treatment was stopped, the patient experienced AF recurrence. Upon receiving verapamil again, the AF again converted into sinus rhythm. LESSONS: For the treatment of AF, nondihydropyridine calcium antagonists can be tried in the absence of antiarrhythmic drugs.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Verapamil/uso terapêutico , Idoso de 80 Anos ou mais , Amiodarona/uso terapêutico , Comorbidade , Feminino , Humanos , Propafenona/uso terapêutico
7.
Med Arch ; 73(1): 19-22, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31097854

RESUMO

Introduction: Postoperative Atrial Fibrillation (POAF) is associated with a higher rate of postoperative complications and mortality, as well as with longer hospitalization and increased treatment costs. We have designed and performed a randomized, trial of pharmacological prophylaxis in which the event of interest is POAF. Aim: The aim of this study is to reduce the risk of postoperative, complications associated with this arrhythmia. Methods: We included 240 stable patients with a coronary heart disease, who were referred to elective surgical revascularization of the myocardium. The patients were assigned into three groups of 80 patients each: group A (BB, beta blocker, comparator), group B (BB+ Amiodarone) and group C (BB + Rosuvastatin). The goal was to establish whether intervention by combination therapy was more useful than a comparator. Results: An event of interest (POAF) has occurred in 66 of the total 240 patients. Number of new POAF cases is the lowest in Group B, 14 (17.5%) compared to 25 (31.25%) new cases in the comparator group, and 27 new cases (33.75%) in group C. Absolute risk reduction was 13.75%, ≈14% less POAF in group B compared to comparator. Relative risk reduction was 56% (RR 0.56, p = 0.04). Number Needed to Treat was 7.27. In group C, 33.75% of patients developed POAF. Absolute risk was insignificantly higher in group C (2.5%, NS) compared to the comparator .The number needed to harm was high, 40. Conclusion: The results of our research show that prophylaxis of POAF with combined therapy BB + Amiodarone was the most efficient one.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/prevenção & controle , Revascularização Miocárdica/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Rosuvastatina Cálcica/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/etiologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Complicações Pós-Operatórias/etiologia , Rosuvastatina Cálcica/administração & dosagem
8.
Arh Hig Rada Toksikol ; 70(1): 49-53, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30956216

RESUMO

Cardiovascular toxicity is the most common cause of fatality in the first 24 hours of poisoning with aluminium phosphide (AlP). Most often manifesting itself in cardiac dysrhythmias. The aim of this study was to evaluate the benefits of amiodarone prophylaxis against cardiac dysrhythmia in 46 patients with acute AlP poisoning. They were divided in two groups of 23: one receiving amiodarone and the other not (control). The treatment group received amiodarone prophylaxis in the initial intravenous bolus dose of 150 mg, followed by a drip of 1 mg/min for six hours and then of 0.5 mg/min for eighteen hours. Both groups were Holter-monitored for 24 hours since admission. Save for amiodarone, both groups received the same standard treatment. Amiodarone had a significant beneficial effect in reducing the frequency of ST-segment elevation and ventricular fibrillation plus atrial fibrillation (P=0.02 and P=0.01, respectively), but the groups did not differ significantly in mortality (9 vs 11 patients, respectively). The mean time between ICU admission and death (survival time) was significantly longer in the treatment group (22 vs 10 h, respectively; P=0.03). Regardless its obvious limitations, our study suggests that even though amiodarone alone did not reduce mortality, it may provide enough time for antioxidant therapy to tip the balance in favour of survival and we therefore advocate its prophylactic use within the first 24 h of AlP poisoning.


Assuntos
Compostos de Alumínio/envenenamento , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Serviços Médicos de Emergência/normas , Praguicidas/envenenamento , Fosfinas/envenenamento , Fibrilação Ventricular/tratamento farmacológico , Adolescente , Adulto , Fibrilação Atrial/etiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Irã (Geográfico) , Masculino , Guias de Prática Clínica como Assunto , Fibrilação Ventricular/etiologia , Adulto Jovem
9.
J Thorac Cardiovasc Surg ; 158(1): 301-310.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30853230

RESUMO

OBJECTIVES: Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. METHODS: In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission ß-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. RESULTS: The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P = .015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P = .001), bradycardia (8.2% vs 0.0%; P = .002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤ .0001) were significantly higher in the amiodarone group. CONCLUSIONS: Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.


Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/prevenção & controle , Esofagectomia/efeitos adversos , Idoso , Amiodarona/administração & dosagem , Amiodarona/efeitos adversos , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/etiologia , Estudos de Casos e Controles , Quimioprevenção/métodos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 98(7): e14544, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762798

RESUMO

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.


Assuntos
Terapia por Acupuntura/métodos , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/terapia , Projetos de Pesquisa , Terapia por Acupuntura/efeitos adversos , Fatores Etários , Amiodarona/administração & dosagem , Amiodarona/efeitos adversos , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Terapia Combinada , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais
11.
Nat Rev Cardiol ; 16(7): 417-436, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30792496

RESUMO

Postoperative atrial fibrillation (POAF) complicates 20-40% of cardiac surgical procedures and 10-20% of non-cardiac thoracic operations. Typical features include onset at 2-4 days postoperatively, episodes that are often fleeting and a self-limited time course. Associated adverse consequences of POAF include haemodynamic instability, increased risk of stroke, lengthened hospital and intensive care unit stays and greater costs. Underlying mechanisms are incompletely defined but include intraoperative and postoperative phenomena, such as inflammation, sympathetic activation and cardiac ischaemia, that combine to trigger atrial fibrillation, often in the presence of pre-existing factors, making the atria vulnerable to atrial fibrillation induction and maintenance. A better understanding of the underlying mechanisms might enable the identification of new therapeutic targets. POAF can be prevented by targeting autonomic alterations and inflammation. ß-Blocker prophylaxis is the best-established preventive therapy and should be started or continued before cardiac surgery, unless contraindicated. When POAF occurs, rate control usually suffices, and routine rhythm control is unnecessary; rhythm control should be reserved for patients who develop haemodynamic instability or show other indications that rate control alone will be insufficient. In this Review, we summarize the epidemiological and clinical features of POAF, the available pathophysiological evidence from clinical and experimental investigations, the results of prophylactic and therapeutic approaches and the consensus recommendations of various national and international societies.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/prevenção & controle , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/fisiopatologia , Antagonistas Adrenérgicos beta/uso terapêutico , Amiodarona/uso terapêutico , Animais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Estimulação Cardíaca Artificial , Átrios do Coração , Frequência Cardíaca , Humanos , Isquemia Miocárdica/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Sotalol/uso terapêutico
12.
J Emerg Med ; 56(3): 308-318, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30711368

RESUMO

BACKGROUND: Recent-onset atrial fibrillation (RAF) is the most frequent supraventricular dysrhythmia in emergency medicine. Severely compromised patients require acute treatment with injectable drugs OBJECTIVE: The main purpose of this external validity study was to compare the short-term efficacy of esmolol with that of amiodarone to treat severe RAF in an emergency setting. METHODS: This retrospective survey was conducted in mobile intensive care units by analyzing patient records between 2002 and 2013. We included RAF with (one or more) severity factors including: clinical shock, angina pectoris, ST shift, and very rapid ventricular rate. A blind matching procedure was used to constitute esmolol group (n = 100) and amiodarone group (n = 200), with similar profiles for age, gender, initial blood pressure, heart rate, severity factors, and treatment delay. The main outcome measure was the percentage of patients with a ventricular rate control defined as heart frequency ≤ 100 beats/min. More stringent (rhythm control) and more humble indicators (20% heart rate reduction) were analyzed at from 10 to 120 min after treatment initiation. RESULTS: Patient characteristics were comparable for both groups: age 66 ± 16 years, male 71%, treatment delay < 1 h 36%, 1-2 h 29%, > 2 h 35%, chest pain 61%, ST shift 62%, ventricular rate 154 ± 26 beats/min, and blood pressure 126/73 mm Hg. The superiority of esmolol was significant at 40 min (64% rate control with esmolol vs. 25% with amiodarone) and for all indicators from 10 to 120 min after treatment onset. CONCLUSION: In "real life emergency medicine," esmolol is better than amiodarone in the treatment of RAF.


Assuntos
Amiodarona/normas , Fibrilação Atrial/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Propanolaminas/normas , Antagonistas de Receptores Adrenérgicos beta 1/normas , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Amiodarona/uso terapêutico , Antiarrítmicos/normas , Antiarrítmicos/uso terapêutico , Medicina de Emergência/métodos , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propanolaminas/uso terapêutico , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo
13.
Pharmacology ; 103(3-4): 179-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30695778

RESUMO

OBJECTIVE: The study sought to assess the long-term prognostic impact of different pharmacotherapies, including angiotensin-converting enzyme inhibitor-inhibitor/angiotensin receptor blocker (ACEi/ARB), statins, and amiodarone in patients with electrical storm (ES). BACKGROUND: Data regarding the outcome of patients with ES is limited. METHODS: Consecutive patients with ES from 2002 to 2016 were included. Patients on ACEi/ARB were compared to patients without ACEi/ARB, respectively, for statin and amiodarone therapy. The primary prognostic endpoint was all-cause mortality at 4 years. Secondary endpoints comprised ES recurrences, rehospitalization, and major adverse cardiac events (MACE) at 4 years. Kaplan-Meier survival curves and multivariable Cox regression analyses were applied. RESULTS: A total of 84 consecutive patients surviving episodes of ES was included. Beta-blocker was given in 95%, ACEi/ARB in 80%, statin in 60%, and amiodarone in 54%. ACEi/ARB patients were associated with improved all-cause mortality at 4 years (mortality rate 34 vs. 65%, log rank p = 0.018; HR 0.428; 95% CI 0.208-0.881; p = 0.021), as well as improved freedom from MACE. In contrast, statin and amiodarone therapy had no impact on long-term outcomes in ES patients. CONCLUSION: ACEi/ARB therapy is associated with improved survival and MACE in patients with ES, whereas statins and amiodarone therapy had no impact on long-term prognostic endpoints.


Assuntos
Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiodarona/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antiarrítmicos/efeitos adversos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Dispositivos de Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Bioconjug Chem ; 30(3): 733-740, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30615425

RESUMO

Amiodarone is an effective antiarrhythmic drug used to treat and prevent different types of cardiac arrhythmias. However, amiodarone can have considerable side effects resulting from accumulation in off-target tissues. Cardiac macrophages are highly prevalent tissue-resident immune cells with importance in homeostatic functions, including immune response and modulation of cardiac conduction. We hypothesized that amiodarone could be more efficiently delivered to the heart via cardiac macrophages, an important step toward reducing overall dose and off-target tissue accumulation. Toward this goal, we synthesized a nanoparticle drug carrier composed of l-lysine cross-linked succinyl-ß-cyclodextrin that demonstrates amiodarone binding through supramolecular host-guest interaction as well as a high macrophage affinity. Biodistribution analyses at the organ and single-cell level demonstrate accumulation of nanoparticles in the heart resulting from rapid uptake by cardiac macrophages. Nanoparticle assisted delivery of amiodarone resulted in a 250% enhancement in the selective delivery of the drug to cardiac tissue in part due to a concomitant decrease of pulmonary accumulation, the main source of off-target toxicity.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Portadores de Fármacos , Coração/efeitos dos fármacos , Amiodarona/farmacocinética , Amiodarona/uso terapêutico , Animais , Antiarrítmicos/farmacocinética , Antiarrítmicos/uso terapêutico , Camundongos , Camundongos Endogâmicos C57BL , Microscopia de Fluorescência , Células RAW 264.7 , Distribuição Tecidual , beta-Ciclodextrinas/farmacocinética
15.
J Oncol Pharm Pract ; 25(5): 1258-1260, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30012045

RESUMO

Ibrutinib is a drug used in several lymphohyperplastic diseases. Its use is associated with an increased risk of atrial fibrillation. New-onset atrial fibrillation in this setting is a true challenge as several antiarrhythmic drugs are not indicated and long-term anticoagulation has several limitations. Herein, we describe our experience in treating a 55-year-old patient receiving ibrutinib who presented with new-onset atrial fibrillation and borderline arterial pressure. Since first-line therapies, electrical cardioversion and ablation, could not be performed, rhythm control with intravenous administration of amiodarone was attempted and led to prompt sinus rhythm restoration. We discuss the therapeutic challenges related to sinus rhythm restoration and anticoagulation in this group of atrial fibrillation patients.


Assuntos
Fibrilação Atrial/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
16.
Interact Cardiovasc Thorac Surg ; 28(2): 227-234, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30084964

RESUMO

OBJECTIVES: This study aims to examine the effects of amiodarone in restoring sinus rhythm in patients with new-onset atrial fibrillation during thoracic operations. METHODS: A total of 12 305 consecutive patients undergoing elective lung/oesophageal surgery were screened. Data analysis included 416 patients with new-onset atrial fibrillation not receiving any antiarrhythmic agents (control group, n = 235) or receiving amiodarone (amiodarone group, n = 181). RESULTS: In the analysis that included all cases (lung and oesophageal surgery), the rate of recovery to sinus rhythm during surgery was 22.1% (52/235) in the control group vs 23.2% (42/181) in the amiodarone group (P = 0.795). A multivariable analysis showed that intraoperative sinus rhythm recovery was not associated with the use of amiodarone [odds ratio 0.91, 95% confidence interval (CI) 0.56-1.50]. Sinus rhythm was achieved eventually during the postoperative period in all patients who failed to achieve sinus rhythm during the surgery (n = 322). However, a Kaplan-Meier analysis showed earlier recovery in the amiodarone group (median time of 1.1 days, 95% CI 0.97-1.24 vs 1.8 days, 95% CI 1.62-2.04; P < 0.001). In a subgroup analysis that only included patients receiving lung surgery (n = 345), the rate of recovery to sinus rhythm during surgery was 17.5% (35/200) in the control group vs 21.4% (31/145) in the amiodarone group (P = 0.366). Time to sinus rhythm recovery was 1.5 days (95% CI 1.48-1.86) in the control group and 1.1 days (95% CI 1.07-1.40) in the amiodarone group (P < 0.001). The rate of severe hypotension after amiodarone treatment was 6.6% (12/181). CONCLUSIONS: Amiodarone does not affect the rate of sinus rhythm recovery during thoracic surgery but could shorten the time to sinus rhythm recovery after the surgery.


Assuntos
Amiodarona/uso terapêutico , Fibrilação Atrial/etiologia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/fisiopatologia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
A A Pract ; 12(4): 119-121, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30169383

RESUMO

Myxedema coma is a rare but highly fatal condition with reported mortality >40%-50%. Early recognition and prompt treatment are critical for survival. Here we describe a case of possible postoperative myxedema coma after subacute neck hematoma evacuation after hemithyroidectomy in a patient on concurrent amiodarone therapy. Symptoms included somnolence, hypothermia, and prolonged QTc with torsades de pointes resistant to magnesium therapy requiring defibrillation and overdrive pacing. Consideration of the possible diagnosis of myxedema coma resulted in prompt therapy and symptom resolution within 48 hours. Thyroid disorders, although rare, should be considered in the postoperative setting.


Assuntos
Coma/etiologia , Mixedema/etiologia , Período Pós-Operatório , Tireoidectomia , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Feminino , Hematoma/etiologia , Humanos , Hipotermia/etiologia , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/cirurgia , Pessoa de Meia-Idade , Pescoço
18.
Ann Endocrinol (Paris) ; 80(1): 54-60, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30236455

RESUMO

Amiodarone, a benzofuranic iodine-rich pan-anti-arrhythmic drug, induces amiodarone-induced thyrotoxicosis (AIT) in 7-15% of patients. AIT is a major issue due to its typical severity and resistance to anti-thyroid measures, and to its negative impact on cardiac status. Classically, AIT is either an iodine-induced thyrotoxicosis in patients with abnormal thyroid (type 1), or due to acute thyroiditis in a "healthy" thyroid (type 2). Determination of the type of AIT is a diagnostic dilemma, as characteristics of both types may be present in some patients. As it is the main etiological factor in AIT, it is recommended that amiodarone treatment should be stopped; however, it may be the only anti-arrhythmic option, needing to be either continued or re-introduced to improve cardiovascular survival. Recently, a few studies demonstrated that amiodarone could be continued or re-introduced in patients with history of type-2 AIT. However, in the other patients, it is recommended that amiodarone treatment be interrupted, to improve response to thioamides and to alleviate the risk of AIT recurrence. In such patients, thyroidectomy is recommended once AIT is under control, allowing safe re-introduction of amiodarone.


Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos , Tireotoxicose/induzido quimicamente , Amiodarona/uso terapêutico , Humanos , Recidiva , Fatores de Risco , Taquicardia/tratamento farmacológico , Tioamidas/uso terapêutico , Tireoidectomia , Tireotoxicose/classificação , Tireotoxicose/terapia
19.
Am J Emerg Med ; 37(2): 376.e3-376.e7, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30415983

RESUMO

BACKGROUND: Brugada pattern is a well-known pathological finding on electrocardiogram (ECG) which increases the likelihood of cardiac arrest due to ventricular arrhythmia. These cases generally present in younger patients without evidence of an electrolyte abnormality, structural heart disease, or cardiac ischemia. In many instances, this pattern is either hidden on initial presentation or presents as an incidental finding on an EKG. Often times the Brugada syndrome leads to sudden cardiac death or more rarely can be unmasked with a class 1A or 1C anti-arrhythmic agent. Here, we present a distinctive case in which the pattern was exposed by amiodarone during the emergent treatment of Ventricular Tachycardia (VT). CASE REPORT: A 34-year-old female, without significant cardiac history, presented to the Emergency Department after multiple near syncopal episodes at home. Initial ECG showed VT vs. SVT. After a failed trial of adenosine, the patient was treated with 150 mg amiodarone and became hypotensive needing an electrical cardioversion. After becoming bradycardic, the amiodarone drip was discontinued and she was admitted to the MICU. An echocardiogram and left heart catheterization showed no evidence of coronary artery disease or decreased ejection fraction. The patient's ECG now showed a subtle Brugada Type 3 pattern and she received a dual chamber AICD upon discharge. CONCLUSION: This case emphasizes the awareness needed to seek out this pattern on subsequent ECG's. With the high lethality of Brugada, the emergency physician must recognize that multiple drugs can evoke this pattern after initial presentation.


Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Desfibriladores Implantáveis , Taquicardia Ventricular/tratamento farmacológico , Adulto , Síndrome de Brugada/fisiopatologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos , Taquicardia Ventricular/fisiopatologia
20.
Int J Infect Dis ; 78: 50-56, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30385404

RESUMO

OBJECTIVES: Levofloxacin and amiodarone are both known to prolong the QT interval. This study was conducted to estimate the risk of cardiac events in patients receiving concomitant levofloxacin and amiodarone. METHODS: The study included patients who were admitted to a large academic community medical center from 1/2012 to 12/2015 and received both levofloxacin and amiodarone at some point during their hospitalization. Patients received concomitant or non-concomitant levofloxacin and amiodarone during hospitalization. The primary outcome was the occurrence of cardiac events during therapy. The secondary outcome was the proportion of patients with an electrocardiogram performed before and after initiation of therapy. Odds ratios for cardiac events were calculated using a multivariable logistic regression model with and without adjusting for the study variables. The concomitant group was further evaluated for predictors of the primary outcome using multivariable logistic regression. RESULTS: This study included 240 patients, 164 (68.3%) of whom received concomitant levofloxacin and amiodarone. Concomitant medication therapy was associated with a greater than six-fold increased risk of cardiac events after adjusting for the study variables (Odds Ratio=6.20; 95% Confidence Interval=1.34-28.62). CONCLUSIONS: Patients receiving concomitant amiodarone and levofloxacin experienced a five-fold increase in cardiac events compared to patients given either medication alone.


Assuntos
Amiodarona/efeitos adversos , Arritmias Cardíacas/epidemiologia , Morte , Levofloxacino/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiodarona/uso terapêutico , Índice de Massa Corporal , Quimioterapia Combinada , Eletrocardiografia , Feminino , Hospitalização , Humanos , Levofloxacino/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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