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High-dosage continuous amiodarone therapy to treat new-onset supraventricular tachyarrhythmias in surgical intensive care patients: an observational study

Hochdosierte kontinuierliche Amiodaron-Therapie zur Behandlung neu aufgetretener supraventrikulärer Tachyarrhythmien bei chirurgischen Intensivpatienten: eine Observationsstudie

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Zusammenfassung

Ziel

Neu aufgetretene supraventrikuläre Rhythmusstörungen (SVRS) stellen eine Komplikation dar, die wesentlich zur Morbidität und Mortalität von chirurgischen Intensivpatienten beiträgt. Obwohl nur wenige Daten über Effektivität bekannt sind, werden Klasse III Antiarrhythmika häufig zur Therapie neu aufgetretener SVRS bei chirurgischen Intensivpatienten verwendet.

Studienort

Allgemeine und chirurgische Intensivstation mit 12 Betten in einem Universitätslehrkrankenhaus.

Design

Retrospektive Observationsstudie.

Patienten

131 chirurgische Intensivpatienten mit SVRS (Nicht-Sinus Schmalkomplextachykardie mit Herzfrequenzen ≥100 Schlägen/min).

Interventionen

Hochdosierte kontinuierliche Amiodaron Infusion entsprechend eines institutionellen Behandlungsprotokols.

Messungen

Hämodynamische Daten, Säure-Basen-Status, und Einzelorganfunktionen wurden vor, 12, 24 und 48 Stunden nach dem Beginn der Amiodaron Infusion bei allen Patienten erfasst. Die Amiodaron Infusion (mittlere Dosis 24 h: 1625±528 mg; 48 h: 2708±895 mg) führte in 54% der Studienpatienten nach 12 h, in 64% nach 24 h und in 75% nach 48 h zur Wiederherstellung eines Sinusrhythmus. Herzfrequenz, zentralvenöser Druck, und Milrinon-Bedarf reduzierten sich signifikant bei allen Patienten. Dies war begleitet von einem signifikanten Anstieg des Schlagvolumenindex und des mittleren arteriellen Blutdrucks. Serumkreatinin- und-bilirubinkonzentrationen stiegen bei allen Patienten signifikant an.

Schlussfolgerung

Innerhalb von 48 Stunden führte eine hochdosierte kontinuierliche Amiodaron Infusion bei 75% der chirurgischen Intensivpatienten mit neu aufgetretenen SVRS und moderatem bis schwerem Multiorgandysfunktionssyndrom zu einer Konversion in einen SR. Eine signifikante Verbesserung der kardiozirkulatorischen Funktion war bei Patienten, welche unter Amiodaron Therapie in einen Sinusrhythmus konvertierten, deutlicher, allerdings konnte eine solche ebenso unabhängig von der Herstellung eines Sinusrhythmus nachgewiesen werden. Neben eines möglicherweise durch Amiodaron mediierten Anstiegs der Serumkreatinin- und-bilirubinkonzentrationen, wurden während des Studienzeitraumes keine wesentlichen Medikamenten-assoziierten Nebenwirkungen beobachtet.

Summary

Background

New-onset supraventricular tachyarrhythmias (SVTA) are a complication contributing significantly to morbidity and mortality in surgical intensive care unit (SICU) patients. Although only few data on efficiency can be found in the literature, class III antiarrhythmics have become popular in the treatment of SVTA in critically ill patients.

Setting

12-bed general and surgical ICU in a university teaching hospital.

Design

Observational, retrospective study.

Patients

131 SICU patients with SVTA (narrowcomplex non-sinus tachyarrhythmias with heart rates ≥100 bpm).

Intervention

High-dosage amiodarone infusion according to an institutional protocol.

Measurements

Hemodynamic data, acid-base status, and single organ functions were obtained in all patients before amiodarone infusion and at 12, 24, and 48 hours afterwards. Patients were divided into responders and nonresponders. Amiodarone infusion (mean dosage 24h: 1625±528 mg; 48h: 2708±895 mg) restored sinus rhythm in 54% of study patients within 12 h, in 64% within 24 h, and in 75% within 48 h. Heart rate, central venous pressure, and milrinone requirements significantly decreased in all patients; this was accompanied by a significant increase in stroke-volume index and mean arterial pressure. Serum concentrations of creatinine and bilirubin increased in all patients.

Conclusion

High-dosage continuous amiodarone infusion during a period of 48 hours resulted in restoration of SR in 75% of SICU patients with new-onset SVTA and moderate to severe multiple-organ dysfunction syndrome. A significant improvement in cardiocirculatory function was more pronounced in responders but could be demonstrated irrespective of restoration of sinus rhythm in all patients. Apart from a possibly amiodarone-mediated increase in concentrations of creatinine and bilirubin, no major drug-related adverse effects occurred during the observation period.

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References

  1. Artucio H, Pereira M (1990) Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med 18: 1383–1388

    Article  PubMed  CAS  Google Scholar 

  2. Brathwaite D, Weissman C (1998) The new-onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest 114: 462–468

    Article  PubMed  CAS  Google Scholar 

  3. Knotzer H, Mayr A, Ulmer H, Lederer W, Schobersberger W, Mutz N, et al (2000) Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study. Intensive Care Med 26: 908–914

    Article  PubMed  CAS  Google Scholar 

  4. Mayr A, Knotzer H, Pajk W, Luckner G, Ritsch N, Dünser M, et al (2001) Risk factors associated with new-onset tachyarrhythmias after cardiac surgery — a retrospective analysis. Acta Anaesthesiol Scand 45: 543–549

    Article  PubMed  CAS  Google Scholar 

  5. Nathanson MH, Gajraj NM (1998) The peri-operative management of atrial fibrillation. Anaesthesia 53: 665–676

    Article  PubMed  CAS  Google Scholar 

  6. Bender JS (1996) Supraventricular tachyarrhythmias in the surgical intensive care unit: an underrecognized event. Am Surg 62: 73–75

    PubMed  CAS  Google Scholar 

  7. Mayr A, Ritsch N, Knotzer H, Dünser M, Schobersberger W, Ulmer H, et al (2003) Effectiveness of direct current cardioversion for treatment of supraventricular tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients. Crit Care Med 31: 401–405

    Article  PubMed  Google Scholar 

  8. Vietti-Ramus G, Veglio F, Marchisio U, Burzio P, Latini R (1992) The efficacy and safety of short intravenous amiodarone in supraventricular tachyarrhythmias. Int J Cardiol 35: 77–85

    Article  PubMed  CAS  Google Scholar 

  9. Strasberg B, Arditti A, Sclarowski S, Lewin RF, Buimivici B, Agmon J (1985) Efficacy of intravenous amiodarone in the management of paroxysmal atrial fibrillation with fast ventricular response. Int J Cardiol 7: 47–55

    Article  PubMed  CAS  Google Scholar 

  10. Levine JH, Massumi A, Scheinmann MM, et al (1996) Intravenous amiodarone for recurrent sustained ventricular tachyarrhythmia. J Am Coll Cardiol 27: 67–75

    Article  PubMed  CAS  Google Scholar 

  11. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definition for sepsis and organfailure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874

    Google Scholar 

  12. Laird NM, Ware JH (1982) Random effects models for longitudinal data. Biometrics 38: 963–974

    Article  PubMed  CAS  Google Scholar 

  13. Hughes M, Binning A (2000) Intravenous amiodarone in intensive care. Time for a reappraisal. Intensive Care Med 26: 1730–1739

    Article  PubMed  CAS  Google Scholar 

  14. Kumar A (1996) Intravenous amiodarone for therapy of atrial fibrillation and flutter in critically ill patients with severely depressed left ventricular function. South Med J 89: 779–785

    PubMed  CAS  Google Scholar 

  15. Hou ZY, Chang MS, Chen CY, Tu MS, Lin SL, Chiang HT, et al (1995) Acute treatment of recent onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. Eur Heart J 16: 521–528

    PubMed  CAS  Google Scholar 

  16. Podrid PJ (1995) Amiodarone: reevaluation of an old drug. Ann Intern Med 122: 689–700

    PubMed  CAS  Google Scholar 

  17. Singh SN, Fletcher RD, Fisher SG, Singh BN, Lewis HD, Deedwania Massie BM, et al (1995) Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. N Engl J Med 333: 77–82

    Article  PubMed  CAS  Google Scholar 

  18. Sugiyama A, Satoh J, Hashimoto K (2001) Acute electropharmacological effects of intravenously administered amiodarone assessed in the in vivo canine model. Jpn J Pharmacol 87: 74–82

    Article  PubMed  CAS  Google Scholar 

  19. Schwartz A, Shen E, Morady F, Gillespie K, Scheinman M, Chatterjee K (1983) Hemodynamic effects of intravenous amiodarone in patients with depressed left ventricular tachycardia. Am Heart J 106: 848–856

    Article  PubMed  CAS  Google Scholar 

  20. Shieh JP, Chu CC, Chen JY, Chen YH, Yeh FC, Hsing CH (1999) Acute fatal vasoplegia and asystole induced by intravenous amiodarone after cardiopulmonary bypass in a patient with preoperative cardiogenic shock. Acta Anaesthesiol Sin 37: 205–210

    PubMed  CAS  Google Scholar 

  21. Venkatesh N, Padbury JF, Singh BN (1986) Effects of amiodarone and desethylamiodarone on rabbit myocardial beta-adrenoreceptors and serum thyroid hormones — absence of relationship to serum and myocardial drug concentrations. J Cardiovasc Pharmacol 8: 989–997

    PubMed  CAS  Google Scholar 

  22. Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA (1998) Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias. Am J Cardiol 81: 594–598

    Article  PubMed  CAS  Google Scholar 

  23. Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M et al (2001) Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med 29: 1149–1153

    Article  PubMed  CAS  Google Scholar 

  24. Pollak PT, Sharma AD, Carruthers SG (1993) Creatinine elevation in patients receiving amiodarone correlates with serum amiodarone concentration. Br J Clin Pharmacol 36: 125–127

    PubMed  CAS  Google Scholar 

  25. Gill J, Heel RC, Fitton A (1992) Amiodarone — An overview of its pharmacological properties, and review of its therapeutic use in cardiac arrhythmias. Drugs 43: 69–110

    Article  PubMed  CAS  Google Scholar 

  26. Mason JW (1987) Drug therapy: amiodarone. N Engl J Med 316: 455–466

    Article  PubMed  CAS  Google Scholar 

  27. Rosenbaum MB, Chiale PA, Haedo A, Lazzari JO, Elizari MV (1983) Ten years of experience with amiodarone. Am Heart J 106: 957–964

    Article  PubMed  CAS  Google Scholar 

  28. Donaldson L, Grant IS, Naysmith MR, Thomas JSJ (1998) Acute amiodarone-induced lung toxicity. Intensive Care Med 24: 626–630

    Article  PubMed  CAS  Google Scholar 

  29. Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrere JSF (1985) Multiple-organ failure. Arch Surg 120: 1109–1115

    PubMed  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology, and Critical Care Medicine, Leopold-Franzens-University, Anichstrasse 35, A-6020, Innsbruck, Austria

    Andreas J. Mayr, Martin W. Dünser, Nicole Ritsch, Werner Pajk, Barbara Friesenecker, Hans Knotzer, Volker Wenzel & Walter R. Hasibeder

  2. Department of Medical Biostatistics, Leopold-Franzens-University, Innsbruck, Austria

    Hanno Ulmer

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  1. Andreas J. Mayr
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  2. Martin W. Dünser
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  3. Nicole Ritsch
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  4. Werner Pajk
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  5. Barbara Friesenecker
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  6. Hans Knotzer
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  7. Hanno Ulmer
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  8. Volker Wenzel
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  9. Walter R. Hasibeder
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Correspondence to Andreas J. Mayr.

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No author has a conflict of interest with regard to drugs discussed in this manuscript.

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Mayr, A.J., Dünser, M.W., Ritsch, N. et al. High-dosage continuous amiodarone therapy to treat new-onset supraventricular tachyarrhythmias in surgical intensive care patients: an observational study. Wien Klin Wochenschr 116, 310–317 (2004). https://doi.org/10.1007/BF03040901

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  • DOI: https://doi.org/10.1007/BF03040901

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