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Gerontas A, Avgerinos D, Charitakis K, Maragou H, Drosatos K. 1821-2021: Contributions of physicians and researchers of Greek descent in the advancement of clinical and experimental cardiology and cardiac surgery. Front Cardiovasc Med 2023; 10:1231762. [PMID: 37600045 PMCID: PMC10436502 DOI: 10.3389/fcvm.2023.1231762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
While the role of Greeks in the development of early western medicine is well-known and appreciated, the contributions of modern Greek medical practitioners are less known and often overlooked. On the occasion of the 200-year anniversary of the Greek War of Independence, this review article sheds light onto the achievements of modern scientists of Greek descent in the development of cardiology, cardiac surgery, and cardiovascular research, through a short history of the development of these fields and of the related institutions in Greece. In the last decades, the Greek cardiology and Cardiac Surgery communities have been active inside and outside Greece and have a remarkable presence internationally, particularly in the United States. This article highlights the ways in which Greek cardiology and cardiovascular research has been enriched by absorbing knowledge produced in international medical centers, academic institutes and pharmaceutical industries in which generations of Greek doctors and researchers trained prior to their return to the homeland; it also highlights the achievements of medical practitioners and researchers of Greek descent who excelled abroad, producing ground-breaking work that has left a permanent imprint on global medicine.
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Affiliation(s)
- Apostolos Gerontas
- School of Applied Natural Sciences, Coburg University, Coburg, Germany
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Dimitrios Avgerinos
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, TX, United States
| | - Helena Maragou
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Konstantinos Drosatos
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
- Metabolic Biology Laboratory, Cardiovascular Center, Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Gatson BJ, Swift S, Paranjape V. Successful treatment of prolonged refractory ventricular fibrillation in an anesthetized dog. J Vet Emerg Crit Care (San Antonio) 2021; 32:129-134. [PMID: 34499802 DOI: 10.1111/vec.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a case of successful return of spontaneous circulation in an anesthetized dog that developed spontaneous ventricular fibrillation during CPR that was refractory to multiple defibrillation attempts by utilizing pharmacological antiarrhythmic therapy. CASE SUMMARY Cardiopulmonary arrest occurred during surgical preparation in a 1-year-old German Shepherd Dog under general anesthesia for fluoroscopic implantation of an Amplatz canine duct occluder for treatment of a patent ductus arteriosus. Pulseless electrical activity was initially diagnosed, and resuscitative efforts were immediately initiated, including basic cardiac life support, discontinuation of anesthesia with administration of reversal agents, and low-dose epinephrine administration (0.01 mg/kg, IV). After 10 minutes of CPR, the patient developed ventricular fibrillation and single-dose monophasic defibrillation attempts of escalating energy were performed. Despite these efforts, return of spontaneous circulation was unable to be achieved. However, administration of magnesium sulfate (20 mg/kg, IV) along with an additional single monophasic defibrillation attempt was successful in achieving return of spontaneous circulation. NEW OR UNIQUE INFORMATION PROVIDED Under current advanced cardiac life support guidelines, the best resuscitation strategy for refractory ventricular fibrillation, in which the arrhythmia persists despite multiple defibrillation attempts, remains unclear. This is especially true for veterinary patients, where refractory ventricular fibrillation is an uncommon cardiac arrest rhythm. Although guidelines for the use of antiarrhythmic therapy during cardiac arrest are well established in human medicine, evidence-based guidelines to support best practices in companion animals do not exist due to sparse data gathered through experimental studies. Only a few case reports describe successful return of spontaneous circulation following prolonged ventricular fibrillation in clinical veterinary patients. Although the use of magnesium sulfate as an antiarrhythmic agent during refractory ventricular fibrillation has been previously reported in people, this is the first case to our knowledge of refractory ventricular fibrillation in a dog that responded to magnesium sulfate.
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Affiliation(s)
- Bonnie J Gatson
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Simon Swift
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Vaidehi Paranjape
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Front Cardiovasc Med 2019; 6:158. [PMID: 31750317 PMCID: PMC6848060 DOI: 10.3389/fcvm.2019.00158] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022] Open
Abstract
Ventricular arrhythmia and subsequent sudden cardiac death (SCD) due to acute myocardial infarction (AMI) is one of the most frequent causes of death in humans. Lethal ventricular arrhythmias like ventricular fibrillation (VF) prior to hospitalization have been reported to occur in more than 10% of all AMI cases and survival in these patients is poor. Identification of risk factors and mechanisms for VF following AMI as well as implementing new risk stratification models and therapeutic approaches is therefore an important step to reduce mortality in people with high cardiovascular risk. Studying spontaneous VF following AMI in humans is challenging as it often occurs unexpectedly in a low risk subgroup. Large animal models of AMI can help to bridge this knowledge gap and are utilized to investigate occurrence of arrhythmias, involved mechanisms and therapeutic options. Comparable anatomy and physiology allow for this translational approach. Through experimental focus, using state-of-the-art technologies, including refined electrical mapping equipment and novel pharmacological investigations, valuable insights into arrhythmia mechanisms and possible interventions for arrhythmia-induced SCD during the early phase of AMI are now beginning to emerge. This review describes large experimental animal models of AMI with focus on first AMI-associated ventricular arrhythmias. In this context, epidemiology of first AMI, arrhythmogenic mechanisms and various potential therapeutic pharmacological targets will be discussed.
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Affiliation(s)
- Stefan Michael Sattler
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Department I, University Hospital Grosshadern, LMU Munich, Munich, Germany
| | - Lasse Skibsbye
- Department of Exploratory Toxicology, H. Lundbeck A/S, Copenhagen, Denmark
| | - Dominik Linz
- Medical Department III, Universitätsklinikum des Saarlandes, Homburg, Germany.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Anniek Frederike Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Amiodarone Treatment in the Early Phase of Acute Myocardial Infarction Protects Against Ventricular Fibrillation in a Porcine Model. J Cardiovasc Transl Res 2019; 12:321-330. [PMID: 30617762 PMCID: PMC6707967 DOI: 10.1007/s12265-018-9861-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
Ventricular fibrillation (VF) occurring in the first minutes to hours of acute myocardial infarction (AMI) is a frequent cause of death and treatment options are limited. The aim was to test whether early infusion of amiodarone 10 min after onset of AMI reduced the incidence of VF in a porcine model. Eighteen female Danish landrace pigs were randomized to a control and an amiodarone group. AMI was induced by ligation of the mid-left anterior descending artery for 120 min followed by 60 min of reperfusion. VF occurred in 0/8 pigs treated with amiodarone compared to 7/10 controls (P < 0.01). Amiodarone treatment prolonged RR intervals, reduced dispersion of action potential duration in the infarcted area and mean number of ectopic beats. No negative effects on cardiac output and blood pressure were observed with amiodarone. Amiodarone qualifies as a potential drug candidate to prevent VF in the first minutes to hours of AMI.
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Epstein AE, Olshansky B, Naccarelli GV, Kennedy JI, Murphy EJ, Goldschlager N. Practical Management Guide for Clinicians Who Treat Patients with Amiodarone. Am J Med 2016; 129:468-75. [PMID: 26497904 DOI: 10.1016/j.amjmed.2015.08.039] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
Abstract
Amiodarone, an iodinated benzofuran derivative with Class I, II, III, and IV antiarrhythmic properties, is the most commonly used antiarrhythmic drug used to treat supraventricular and ventricular arrhythmias. Appropriate use of this drug, with its severe and potentially life-threatening adverse effects, requires an essential understanding of its risk-benefit properties in order to ensure safety. The objective of this review is to afford clinicians who treat patients receiving amiodarone an appropriate management strategy for its safe use. The authors of this consensus management guide have thoroughly reviewed and evaluated the existing literature on amiodarone and apply this information, along with the collective experience of the authors, in its development. Provided are management guides on the intravenous and oral dosing of amiodarone, appropriate outpatient follow-up of patients taking the drug, its recognized adverse effects, and recommendations on when to consult specialists to help in patient management. All clinicians must be cognizant of the appropriate use, follow-up, and adverse reactions of amiodarone. The responsibility incurred by those treating such patients cannot be overemphasized.
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Affiliation(s)
- Andrew E Epstein
- Cardiovascular Division, Electrophysiology Section, Department of Medicine, University of Pennsylvania, Philadelphia.
| | | | | | - John I Kennedy
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala; Department of Medicine, Birmingham VA Medical Center, Birmingham, Ala
| | - Elizabeth J Murphy
- Department of Medicine, University of California, San Francisco, Calif; Division of Endocrinology, Department of Medicine, San Francisco General Hospital, San Francisco, Calif
| | - Nora Goldschlager
- Department of Medicine, University of California, San Francisco, Calif; Division of Cardiology, Department of Medicine, San Francisco General Hospital, San Francisco, Calif
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Gerstein NS, Shah MB, Jorgensen KM. Reply to R. M. Lynch: "Guidelines for widespread use?". J Cardiothorac Vasc Anesth 2015; 29:e69-70. [PMID: 26296824 DOI: 10.1053/j.jvca.2015.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine University of New Mexico Albuquerque, New Mexico
| | - Mark B Shah
- Utah Emergency Physicians Intermountain Healthcare Salt Lake City, Utah; Department of Surgery, University of Utah Salt Lake City, Utah
| | - K Michael Jorgensen
- Utah Emergency Physicians Intermountain Healthcare Salt Lake City, Utah; Department of Surgery, University of Utah Salt Lake City, Utah
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Fletcher DJ, Boller M. Updates in small animal cardiopulmonary resuscitation. Vet Clin North Am Small Anim Pract 2013; 43:971-87. [PMID: 23747269 DOI: 10.1016/j.cvsm.2013.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines.
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Affiliation(s)
- Daniel J Fletcher
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, DCS Box 31, Ithaca, NY 14853, USA.
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Rozanski EA, Rush JE, Buckley GJ, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S44-64. [DOI: 10.1111/j.1476-4431.2012.00755.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - John E. Rush
- Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA
| | - Gareth J. Buckley
- College of Veterinary Medicine, University of Florida; Gainesville; FL
| | - Daniel J. Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies, School of Veterinary Medicine and the Department of Emergency Medicine, School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Morita Y, Mizuno J, Yoshimura T, Morita S. Efficacy of amiodarone on refractory ventricular fibrillation resistant to lidocaine and cardioversion during weaning from cardiopulmonary bypass in aortic valve replacement for severe aortic stenosis with left ventricular hypertrophy. J Anesth 2010; 24:761-4. [DOI: 10.1007/s00540-010-0991-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/26/2010] [Indexed: 11/28/2022]
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Ji XF, Li CS, Wang S, Yang L, Cong LH. Comparison of the efficacy of nifekalant and amiodarone in a porcine model of cardiac arrest. Resuscitation 2010; 81:1031-6. [PMID: 20627529 DOI: 10.1016/j.resuscitation.2010.04.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/18/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the efficacy of nifekalant and amiodarone in the treatment of cardiac arrest in a porcine model. METHODS After 4min of untreated ventricular fibrillation, animals were randomly treated with nifekalant (2mgkg(-1)), amiodarone (5mgkg(-1)) or saline placebo (n=12 pigs per group). Precordial compression and ventilation were initiated after drug administration and defibrillation was attempted 2min later. Hemodynamics were continuously measured for 6h after successful resuscitation. RESULTS Compared with saline, nifekalant and amiodarone equally decreased the number of electric shocks, defibrillation energy, epinephrine dose, and duration of cardiopulmonary resuscitation required for successful resuscitation (P<0.01). The incidence of restoration of spontaneous circulation (ROSC) and the 24-h survival rate were higher in both antiarrhythmic drug groups (P<0.05) vs. the saline group. Furthermore, post-resuscitation myocardial dysfunction at 4-6h after successful resuscitation was improved in animals given antiarrhythmic drugs as compared with the saline group (P<0.05). There were no differences between nifekalant and amiodarone for any of these parameters. CONCLUSION The effect of nifekalant was similar to that of amiodarone for improving defibrillation efficacy and for the treatment of cardiac arrest. Administration of either nifekalant or amiodarone before defibrillation increased the ROSC and 24-h survival rates and improved post-resuscitation cardiac function in this porcine model.
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Affiliation(s)
- Xian-Fei Ji
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, 8# Baijiazhuang Road, Chaoyang District, Beijing 100020, China
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11
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Huang X, Yang Y, Zhu J, Gao X, Wang G, Tan H, Liang Y, Li J. Clinical Applications and Acute Hepatotoxicity of Intravenous Amiodarone. J Int Med Res 2009; 37:1928-36. [PMID: 20146893 DOI: 10.1177/147323000903700631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This cross-sectional, retrospective study was designed to evaluate the current clinical applications and acute hepatotoxicity of intravenous amiodarone administration at a hospital in China. Clinical data were collected from 1214 patients receiving intravenous amiodarone treatment between October 2003 and September 2005. Baseline patient characteristics, drug indications, administration records and acute hepatotoxicity associated with the drug were examined. Amiodarone was used primarily in arrhythmic patients with obvious cardiac dysfunction. Atrial fibrillation and ventricular arrhythmia were the two most commonly treated dysfunctions. Incorrect indications and administration methods were also noted. Hepatotoxicity occurred in 12.6% of the patients, but was mild in most cases. Males showed a higher incidence of hepatotoxicity than females. The use of amiodarone was considered to be reasonable and standardized, but there was still considerable room for improvement, particularly in the standardization of administration guidelines. Intravenous amiodarone can cause hepatotoxicity and hepatic function tests should be performed soon after giving amiodarone intravenously.
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Affiliation(s)
- X Huang
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Yang
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Zhu
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Gao
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Wang
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - H Tan
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Liang
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Li
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Leeuwenburgh BPJ, Versteegh MIM, Maas JJ, Dunning J. Should amiodarone or lidocaine be given to patients who arrest after cardiac surgery and fail to cardiovert from ventricular fibrillation? Interact Cardiovasc Thorac Surg 2008; 7:1148-51. [DOI: 10.1510/icvts.2008.188656] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, Murphy E. A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm 2007; 4:1250-9. [PMID: 17765636 DOI: 10.1016/j.hrthm.2007.07.020] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 10/23/2022]
Abstract
Amiodarone is commonly used to treat supraventricular and ventricular arrhythmias in various inpatient and outpatient settings. Over- and under-use of amiodarone is common, and data regarding patterns of use are sparse and largely anecdotal. Because of adverse drug reactions, proper use is essential to deriving optimal benefits from the drug with the least risk. This guide updates an earlier version published in 2000, reviews indications for use of amiodarone and recommends strategies to minimize adverse effects. The recommendations included herein are based on the best available data and the collective experience of the member of the writing committee.
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Tempe DK, Gandhi A, Mehta V, Banerjee A, Datt V, Ramamurthy P, Goyal G. Administration of Amiodarone into the Aortic Root for Persistent Ventricular Fibrillation After Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2007; 21:414-6. [PMID: 17544897 DOI: 10.1053/j.jvca.2007.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak K Tempe
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital, New Delhi, India.
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Tsagalou EP, Anastasiou-Nana MI, Charitos CE, Siafakas CX, Drakos SG, Ntalianis A, Terrovitis JV, Mavrikakis EM, Doufas A, Nanas JN. Time course of fibrillation and defibrillation thresholds after an intravenous bolus of amiodarone--an experimental study. Resuscitation 2004; 61:83-9. [PMID: 15081186 DOI: 10.1016/j.resuscitation.2003.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Revised: 11/03/2003] [Accepted: 12/03/2003] [Indexed: 11/18/2022]
Abstract
UNLABELLED Experimental studies have described an increase in ventricular fibrillation threshold (VFT) by intravenous amiodarone. The aim of this study was to examine the early time course of changes in VFT and defibrillation thresholds (DFT) after an intravenous bolus of amiodarone in an experimental pig model of transient myocardial ischemia. METHODS AND RESULTS VFT and relative effective ventricular refractory period (ERP) were measured in 15 anaesthetized open-chest pigs after 3 min of regional coronary ischaemia before (time 0) and 2, 15, 30, 60, and 90 min after the intravenous injection of normal saline (group A, n = 5) or amiodarone, 5 mg/kg over 15 s (group B, n = 10). DFT was measured by increasing the strength of DC shocks until defibrillation was accomplished. Amiodarone caused an increase in VFT, starting at 2 min after the infusion (11.4 +/- 8.4 mA versus 9.2 +/- 4.6 mA, P = 0.03), became significant at 15 min (13.7 +/- 6.5 mA, P = 0.009), continued to rise at 30 min (34.2 +/- 28.7 mA, P = 0.03) and reached a plateau at 60 min (50.3 +/- 37.8 mA, P = 0.008). An increase was also observed in the ERP (204 +/- 25 ms at 2 min versus 197 +/- 26 ms at baseline, P = 0.074, 211 +/- 38 ms at 15 min, P = 0.084, 212 +/- 40 ms at 30 min, P = 0.037, 220 +/- 34 ms at 60 min, P = 0.002, and 227 +/- 32 ms at 90 min, P = 0.008). No change was observed in DFT after amiodarone administration. No significant change in VFT, ERP, or DFT occurred in the control group. CONCLUSION In this porcine model, the intravenous administration of amiodarone increased VFT and ERP over 60 min after the injection, without effect on DFT.
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Affiliation(s)
- Eleftheria P Tsagalou
- Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra Hospital, Makedonias 24, 104 33 Athens, Greece
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Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002; 346:884-90. [PMID: 11907287 DOI: 10.1056/nejmoa013029] [Citation(s) in RCA: 574] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lidocaine has been the initial antiarrhythmic drug treatment recommended for patients with ventricular fibrillation that is resistant to conversion by defibrillator shocks. We performed a randomized trial comparing intravenous lidocaine with intravenous amiodarone as an adjunct to defibrillation in victims of out-of-hospital cardiac arrest. METHODS Patients were enrolled if they had out-of-hospital ventricular fibrillation resistant to three shocks, intravenous epinephrine, and a further shock; or if they had recurrent ventricular fibrillation after initially successful defibrillation. They were randomly assigned in a double-blind manner to receive intravenous amiodarone plus lidocaine placebo or intravenous lidocaine plus amiodarone placebo. The primary end point was the proportion of patients who survived to be admitted to the hospital. RESULTS In total, 347 patients (mean [+/-SD] age, 67+/-14 years) were enrolled. The mean interval between the time at which paramedics were dispatched to the scene of the cardiac arrest and the time of their arrival was 7+/-3 minutes, and the mean interval from dispatch to drug administration was 25+/-8 minutes. After treatment with amiodarone, 22.8 percent of 180 patients survived to hospital admission, as compared with 12.0 percent of 167 patients treated with lidocaine (P=0.009; odds ratio, 2.17; 95 percent confidence interval, 1.21 to 3.83). Among patients for whom the time from dispatch to the administration of the drug was equal to or less than the median time (24 minutes), 27.7 percent of those given amiodarone and 15.3 percent of those given lidocaine survived to hospital admission (P=0.05). CONCLUSIONS As compared with lidocaine, amiodarone leads to substantially higher rates of survival to hospital admission in patients with shock-resistant out-of-hospital ventricular fibrillation.
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Affiliation(s)
- Paul Dorian
- Departments of Medicine and Emergency Medicine, St. Michael's Hospital, Toronto.
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Abstract
As exemplified in this discussion of ACLS antiarrhythmic drugs, the evidence-based evaluation process has created a high standard for the acceptance and ranking of therapies for cardiac arrest. This process also has identified critical areas needing further investigation, fostered a healthy sense of discomfort with the adequacy of our present interventions for cardiac arrest, and hopefully will continue to spur the science while sifting the dogma out of CPR.
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Affiliation(s)
- Peter J Kudenchuk
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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Bicer S, Schwartz D, Nakayama T, Hamlin R. Hemodynamic and Electrocardiographic Effects of Graded Doses of Amiodarone in Healthy Dogs Anesthetized with Morphine/Alpha Chloralose. J Vet Intern Med 2000. [DOI: 10.1111/j.1939-1676.2000.tb01505.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mitchell RG, Guly UM, Rainer TH, Robertson CE. Paramedic activities, drug administration and survival from out of hospital cardiac arrest. Resuscitation 2000; 43:95-100. [PMID: 10694168 DOI: 10.1016/s0300-9572(99)00131-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the impact of administration of cardioactive drugs on the outcome from out of hospital cardiac arrest. DESIGN Longitudinal observational cohort study with historical controls before and after the introduction of drug use in cardiac arrest by paramedics. SUBJECTS Adult patients who had sustained an out of hospital cardiac arrest of cardiac aetiology and were treated by paramedics. SETTING Edinburgh, Scotland. OUTCOME MEASURES Return of spontaneous circulation, admission to and discharge from hospital. RESULTS There was no significant difference in the demographics between Period 1 (prior to drug administration) and Period 2 (after). There was no difference in outcome between Period 1 and Period 2 for all three parameters, return of spontaneous output 30.1 versus 35%, admission to hospital 18.9 versus 24.5% and discharge 5.8 versus 6.5%. If the presenting rhythm of VF/pulseless VT alone was considered survival to hospital discharge was 12.1% in Period 1 and 10.3% in Period 2. CONCLUSION The addition of cardioactive drug administration to the treatment of out of hospital cardiac arrest does not improve survival.
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Affiliation(s)
- R G Mitchell
- Department of Accident and Emergency Medicine and Surgery, The Royal Infirmary of Edinburgh, UK
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22
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Abstract
Prompt cardiopulmonary resuscitation (CPR) and early defibrillation significantly improve the likelihood of successful resuscitation from cardiac arrest and are the key components in the American Heart Association's "chain of survival." Although representing current clinical practice in the United States, there is limited evidence supporting the benefit of acute administration of such antiarrhythmic medications as lidocaine, bretylium, magnesium, and procainamide to a victim of cardiac arrest. There has been only 1 published case-controlled clinical trial in which shock-refractory victims of out-of-hospital ventricular fibrillation were stratified into those who received lidocaine and those who did not. In this trial, no significant differences were observed between treatment groups in the return of an organized rhythm, admission to the hospital, or survival to hospital discharge. In the recently published ARREST trial, a significant improvement in admission alive to the hospital was observed in recipients of intravenous amiodarone, compared with placebo (44% vs 34%, respectively, p = 0.03). With the possible exception of intravenous amiodarone, available evidence of definitive benefit from antiarrhythmic drugs in cardiac arrest is inconclusive. Due to regulatory issues, clinical trials in cardiac arrest are extremely difficult to design and perform.
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Affiliation(s)
- P J Kudenchuk
- University of Washington, Division of Cardiology, Seattle 98195-6422, USA
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23
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Nanas JN, Mason JW. Pharmacokinetics and regional electrophysiological effects of intracoronary amiodarone administration. Circulation 1995; 91:451-61. [PMID: 7805250 DOI: 10.1161/01.cir.91.2.451] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The reason for the delay in onset of the electrophysiological effects and antiarrhythmic efficacy of amiodarone is not clear. The relation between the development of the electrophysiological effects of amiodarone and its myocardial concentration is unknown. We therefore examined the time course of development of electrophysiological effects during intracoronary infusion of amiodarone and related these changes to myocardial concentrations. METHODS AND RESULTS Amiodarone (0.139 mg/min) or normal saline was infused for 10 hours into the proximal left anterior descending coronary artery of 24 open-chest dogs. Nineteen animals received intracoronary amiodarone and 5 received normal saline (control group). Ten of the 19 that received amiodarone underwent electrophysiological study (amio-EPS group). Sixteen of the 19, including 7 from the amio-EPS group, underwent pharmacological study (PS group). In the amio-EPS group during pacing at a cycle length of 300 ms, changes in conduction velocities in drug-exposed myocardium referenced to nonexposed myocardium at 1 hour of infusion were -3.7% in the longitudinal direction (P = NS) and -7.2% in the transverse direction (P < .05); at 3 hours, -12.9% (P < .05) and -9.1% (P < .05); and at 9 hours, -32.9% (P < .02) and -31.7% (P < .01). These changes were dependent on amiodarone concentration (R2 = .83). There was also an obvious rate-dependent effect that was more pronounced for transverse conduction velocities. This effect was also dependent on amiodarone concentration. In the PS group, amiodarone levels in the drug-exposed myocardium increased from a mean of 5.95 microgram/g at 15 minutes of infusion to 188.88 microgram/g at the 10th hour. This increase was time dependent (R2 = .91). In the nonexposed myocardium, amiodarone levels were always low and increased minimally over time from a mean of 2.68 to 14.45 microgram/g. This increase was also time dependent (R2 = .97). CONCLUSIONS Selective intracoronary amiodarone infusion resulted in selective drug accumulation and concomitant time-dependent reduction of myocardial conduction velocity. There was a significant correlation between the extent of reduction of conduction velocity and myocardial amiodarone concentration but not coronary arterial or systemic concentration. Repolarization was not significantly altered.
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Affiliation(s)
- J N Nanas
- University of Athens, School of Medicine, Greece
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