#AMIODARONE HALF LIFE TRIAL#
9, 10īased on the trial results, rate control is preferred to rhythm control for patients with atrial fibrillation. Other, smaller studies have shown similar increases in non-cardiac mortality in patients taking amiodarone. 9 The majority of the patients treated with rhythm control in AFFIRM were managed with amiodarone. There were no differences between the two groups in terms of cardiovascular mortality, deaths due to arrhythmia, vascular events or rates of ischaemic stroke. 8 The differences were partly explained by non-cardiac deaths with antiarrhythmic therapy that was thought to be more toxic in those with serious medical conditions. 7 In fact, the AFFIRM study of over 4000 patients showed a trend towards increased mortality with rhythm control, particularly in older patients. They found no significant difference in all-cause mortality, cardiovascular death and composite end points including death, stroke, major bleeding, cardiac arrest and congestive cardiac failure. Several major trials have compared rate and rhythm control in patients with atrial fibrillation. The primary goals in management are to prevent disabling symptoms through rhythm or rate control and to reduce the risk of stroke with anticoagulation. 6Ītrial fibrillation is the commonest arrhythmia in older adults, with an estimated prevalence of 9% in people over the age of 80 years. 4Īmiodarone is one the most frequently prescribed antiarrhythmic drugs for atrial fibrillation. 3 Its use is also implicated in a range of drug–drug interactions with commonly prescribed cardiovascular drugs.
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2 A cardiologist’s opinion is recommended before prescribing.Īmiodarone can have adverse effects in multiple organ systems including the lungs, heart, liver, thyroid, gut, skin, nerves and eyes. There is also a lack of information regarding the safety of amiodarone in older people. These adverse effects are particularly problematic for older people who are more susceptible to drug toxicities and who have higher rates of polypharmacy. Although it primarily blocks potassium channels, amiodarone potentiates its effect through all four of the classic Vaughan Williams mechanisms of antiarrhythmic action.ĭespite its efficacy, amiodarone is a challenging drug to use in clinical practice due to its prolonged half-life, multiple adverse effects and drug interactions. Amiodarone, and its active metabolite desethylamiodarone, have multiple effects on cardiac depolarisation and repolarisation. 1 It is commonly used to treat atrial fibrillation and ventricular arrhythmias. Amiodarone is widely considered to be the most effective antiarrhythmic drug available.