Antiarrhythmic Drug Therapy in 2012
Therapies Friday, March 16th, 2012Time to Finally Open Our Eyes!
Content.onlinejacc.org: Michele Coceani, MD* * Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi 1, 56124 Pisa, Italy (Email: michecoc@ftgm.it). March 12, 2012.
I read with interest the study by Saksena et al. (1) recently published in the Journal. Analyzing data from the AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) trial, the authors report that atrial fibrillation patients treated with amiodarone have higher rates of death (noncardiovascular, in particular) and of cardiovascular hospitalization. An adverse effect of amiodarone, especially among patients with heart failure, had been previously observed in a subgroup analysis of the SCD-HeFT (Sudden Cardiac Death in Heart Failure) trial (2), as well as in retrospective analyses of the CIBIS-II (Cardiac Insufficiency Bisoprolol Study II) (3), COMET (Carvedilol or Metoprolol European Trial) (4), and VALIANT (VALsartan In Acute myocardial iNfarcTion) (5) trials. Several mechanisms may be invoked to explain these findings: iatrogenic tachy- and bradyarrhythmias (6), drug-induced left ventricular dysynchrony (7), drug-drug interactions (with digoxin, for example), and extracardiac toxicity (thyroid, liver, lungs) (6). Read More
