-
Cureus Jul 2022The emergency treatment of atrial fibrillation (AF) involves utilizing two strategies. The first strategy normally involves permitting the atrial fibrillation to... (Review)
Review
An Integrative Comparative Study Between Digoxin and Amiodarone as an Emergency Treatment for Patients With Atrial Fibrillation With Evidence of Heart Failure: A Systematic Review and Meta-Analysis.
The emergency treatment of atrial fibrillation (AF) involves utilizing two strategies. The first strategy normally involves permitting the atrial fibrillation to persevere as the ventricular rate is controlled. The other method involves utilizing anti-arrhythmic drugs in cardioversion and attempting to maintain sinus rhythm. Different pharmacological treatments, including digoxin and amiodarone, have been used to manage AF. A literature review on amiodarone and digoxin in the treatment of AF among patients with heart failure (HF) has shown that both drugs have potential risks. Therefore, we are conducting this systematic review and meta-analysis to compare the effectiveness of amiodarone and digoxin in the treatment of AF among patients with evidence of HF. A literature search of relevant articles was conducted on six electronic databases (PubMed, Web of Science, Medline, ScienceDirect, Cochrane Library, and Google Scholar) from 2000 to 2022. The search yielded seven studies that had met the inclusion criteria. Our meta-analysis of four studies showed that there was no significant difference in the reduction of heart rate after treatment with either amiodarone or digoxin (mean difference (MD): -5.44; 95% confidence interval (CI): -9.53 to -1.34; I = 25%; p = 0.26). On the other hand, the statistical analysis showed that amiodarone had a better effect on the conversion to sinus rhythm than digoxin (63% versus 35%, respectively). Based on evidence from our meta-analysis, the clinical effect of amiodarone and digoxin in the emergency treatment of AF on heart rate control was unclear. However, amiodarone has a significant impact on the restoration of sinus rhythm compared with digoxin and can be considered the first-line drug regimen in conversion to sinus rhythm for AF patients with evidence of heart failure. However, the use of amiodarone and digoxin is complicated by adverse events and all-cause mortality.
PubMed: 35971374
DOI: 10.7759/cureus.26800 -
Journal of Cardiovascular Pharmacology Apr 2016Atrial fibrillation (AF), which increases morbidity and mortality, is a common occurrence after thoracic surgery and pulmonary resection. Despite several investigations... (Meta-Analysis)
Meta-Analysis Review
Atrial fibrillation (AF), which increases morbidity and mortality, is a common occurrence after thoracic surgery and pulmonary resection. Despite several investigations on various prophylactic measures for AF prevention, the studies were not uniform and do not use similar controls making it difficult to arrive at a meaningful conclusion. In the present systematic analysis review, we evaluated the efficacy of different prophylactic approaches to prevent AF after lung surgery in randomized trials reported during 1991-2014. A total of 12 trials were identified that met the criteria set for this meta-analysis. Among different trials, amiodarone was found to be most effective in preventing postoperative AF (risk ratio, 0.22; P < 0.0001; 95% confidence interval: 0.09-0.54). There were no significant prophylactic effects by MgSO4 (risk ratio, 1.24; P < 0.007; 95% confidence interval, 0.27-5.68), digoxin, or Ca blockers. Single use of amiodarone was able to lower the incidence of AF from 39.2% to 8.3% and seemed to be safe with no major complications. Although several prophylactic measures have been tried to curtail the incidence of AF in patients after lung surgery, prophylaxis with amiodarone seems to be most effective of treatments studied.
Topics: Amiodarone; Atrial Fibrillation; Humans; Incidence; Lung; Pneumonectomy; Postoperative Complications; Randomized Controlled Trials as Topic; Thoracic Surgical Procedures
PubMed: 26779893
DOI: 10.1097/FJC.0000000000000351 -
The Journal of Emergency Medicine Mar 2018Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these patients have recent-onset AF (<48 h). The poor prognosis associated with AF is being increasingly recognized, and there is some evidence for better outcomes in younger patients with recent-onset AF when sinus rhythm is restored. Flecainide is recommended in the latest international guidelines for cardioversion of recent-onset AF, but its safety and efficacy relative to other recommended agents are unclear.
OBJECTIVE
Our aim was to clarify the Level 1 evidence for the use of i.v. flecainide in acute AF.
METHODS
We performed a systematic review and meta-analysis of the literature. Medline, Ovid, Embase, and Cochrane Central databases were searched for relevant studies. Only randomized controlled trials (RCTs) of i.v. flecainide for acute conversion of recent-onset AF were selected for meta-analysis.
RESULTS
Four hundred and three studies were screened, of which 11 RCTs were eligible for meta-analysis. Flecainide had high efficacy for cardioversion within 2 h (number needed to treat [NNT] = 1.8). Efficacy was superior to propafenone, amiodarone, procainamide, ibutilide, and sotalol (NNT = 4.3). There was no statistically significant difference in pro-dysrhythmia compared to these anti-dysrhythmics or placebo.
CONCLUSIONS
Intravenous flecainide cardioversion could be a safe and effective option for emergency physicians to restore sinus rhythm in selected patients with acute AF.
Topics: Administration, Intravenous; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Electric Countershock; Emergency Service, Hospital; Flecainide; Humans; United Kingdom
PubMed: 29269083
DOI: 10.1016/j.jemermed.2017.11.016 -
Cureus Jun 2022Sudden cardiac death (SCD) is an unexpected death that occurs within one hour of symptom onset. In the United States, sudden cardiac death is considered the leading... (Review)
Review
A Comparative Study Between Amiodarone and Implantable Cardioverter-Defibrillator in Decreasing Mortality From Sudden Cardiac Death in High-Risk Patients: A Systematic Review and Meta-Analysis.
Sudden cardiac death (SCD) is an unexpected death that occurs within one hour of symptom onset. In the United States, sudden cardiac death is considered the leading cause of natural death, accounting for 325,000 adult patients annually. SCD is more common in adult patients (above the mid-30s) and men. The risk factors that predict SCD are categorized into clinical, sociological, genetic, and psychological. To prevent the occurrence of SCD, several treatment options, especially antiarrhythmic drugs and implantable cardioverter-defibrillator (ICD), have been used. A literature search from 2000 to 2022 was conducted on six electronic databases: PubMed, Cochrane Library, Web of Science, Embase, ScienceDirect, and Google Scholar. The search query used Boolean expressions and keywords such as amiodarone, implantable cardioverter-defibrillator, sudden cardiac death, cardiac arrest, arrhythmic death, and all-cause mortality. The articles identified from the literature search were screened using the eligibility criteria, resulting in eight articles relevant for inclusion in the review. A meta-analysis of data from six of the included studies showed that ICD was more effective in the reduction of SCD rates, with an SCD rate of 5.97% (n = 84/1,408) observed in the ICD group compared with an SCD rate of 11.81% (n = 168/1,423) observed in the amiodarone group. The results also show that ICD was more effective in reducing all-cause mortality compared with amiodarone (odds ratio (OR): 1.36; 95% confidence interval (CI): 1.06-1.74; I = 57%; P = 0.03). ICD treatment of high-risk patients was more effective in reducing SCD and all-cause mortality rates compared with amiodarone treatment. There is evidence that amiodarone can be used as an adjuvant treatment option, especially for patients who are not eligible for ICD treatment and those who face more adverse events. Evidence has also shown that using amiodarone with ICD treatment significantly improves survival rates compared to ICD treatment only.
PubMed: 35865418
DOI: 10.7759/cureus.26017 -
Pharmacotherapy Feb 2016Amiodarone remains the mostly frequently used antiarrhythmic in clinical practice and is most often used to maintain normal sinus rhythm in patients with atrial... (Review)
Review
Amiodarone remains the mostly frequently used antiarrhythmic in clinical practice and is most often used to maintain normal sinus rhythm in patients with atrial fibrillation who have failed a rate control strategy. Amiodarone has superior efficacy over other antiarrhythmics, a lower risk of torsade de pointes, and a better cardiovascular safety profile in patients with structural heart disease. However, amiodarone is associated with notable noncardiac toxicities affecting the thyroid, lungs, eyes, liver, and central nervous system. Since 2000, clinicians have been advised to follow amiodarone monitoring guidelines provided by the Heart Rhythm Society. Adherence to these recommendations in clinical practice, however, is suboptimal. Pharmacists play a major role in ensuring the safe and effective use of medications, particularly high-risk medications such as amiodarone. This qualitative review details the evidence supporting the role of pharmacist-led amiodarone monitoring services (AMS) in improving adherence to amiodarone monitoring guidelines and identifying adverse effects. Five studies were identified, and, overall, these programs had a favorable impact on improving adherence to guideline-recommended monitoring standards for amiodarone. The available evidence is limited by the significant variations in study designs and outcome definitions, lack of patient randomization, and limited generalizability. Nevertheless, available studies suggest that pharmacist-led AMS may improve adherence to recommended monitoring guidelines and identification of amiodarone-related adverse effects. Further study is warranted to demonstrate whether these services impact the overall quality of care provided to patients receiving amiodarone, which may justify broader implementation.
Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Drug Monitoring; Evidence-Based Medicine; Guideline Adherence; Humans; International Agencies; Pharmacists; Practice Guidelines as Topic; Professional Role; Quality Improvement; Quality of Health Care
PubMed: 26846446
DOI: 10.1002/phar.1697 -
Pediatric Critical Care Medicine : a... Feb 2017We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone... (Comparative Study)
Comparative Study Review
OBJECTIVE
We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone or lidocaine during pediatric cardiac arrest for the 2015 International Liaison Committee on Resuscitation's Consensus on Science and Treatment Recommendations.
DATA SOURCES
Studies were identified from comprehensive searches in PubMed, Embase, and the Cochrane Library.
STUDY SELECTION
Studies eligible for inclusion were randomized controlled and observational studies on the relative clinical effect of amiodarone or lidocaine in cardiac arrest.
DATA EXTRACTION
Studies addressing the clinical effect of amiodarone versus lidocaine were extracted and reviewed for inclusion and exclusion criteria by the reviewers. Studies were rigorously analyzed thereafter.
DATA SYNTHESIS
We identified three articles addressing lidocaine versus amiodarone in cardiac arrest: 1) a prospective study assessing lidocaine versus amiodarone for refractory ventricular fibrillation in out-of-hospital adults; 2) an observational retrospective cohort study of inpatient pediatric patients with ventricular fibrillation or pulseless ventricular tachycardia who received lidocaine, amiodarone, neither or both; and 3) a prospective study of ventricular tachycardia with a pulse in adults. The first study showed a statistically significant improvement in survival to hospital admission with amiodarone (22.8% vs 12.0%; p = 0.009) and a lack of statistical difference for survival at discharge (p = 0.34). The second article demonstrated 44% return of spontaneous circulation for amiodarone and 64% for lidocaine (odds ratio, 2.02; 1.36-3.03) with no statistical difference for survival at hospital discharge. The third article demonstrated 48.3% arrhythmia termination for amiodarone versus 10.3% for lidocaine (p < 0.05). All were classified as lower quality studies without preference for one agent.
CONCLUSIONS
The confidence in effect estimates is so low that International Liaison Committee on Resuscitation felt that a recommendation to use of amiodarone over lidocaine is too speculative; we suggest that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and children.
Topics: Amiodarone; Anti-Arrhythmia Agents; Child; Combined Modality Therapy; Electric Countershock; Heart Arrest; Humans; Lidocaine; Pediatrics; Resuscitation; Treatment Outcome; Ventricular Fibrillation
PubMed: 28009655
DOI: 10.1097/PCC.0000000000001026 -
The Annals of Thoracic Surgery Dec 2014Atrial fibrillation after thoracic surgery is frequent and increases morbidity and mortality. A number of trials have investigated medical prophylaxis for the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atrial fibrillation after thoracic surgery is frequent and increases morbidity and mortality. A number of trials have investigated medical prophylaxis for the prevention of atrial fibrillation after surgery for lung cancer. However, the literature is diverse and hence difficult to review. The aim of this study was to evaluate the safety and efficacy of reducing the risk of postoperative atrial fibrillation by the use of medical prophylaxis in patients undergoing surgery for lung cancer.
METHODS
A systematic review and meta-analysis of randomized, controlled trials investigating prophylactic medical interventions to reduce the risk of postoperative atrial fibrillation was performed.
RESULTS
A total number of 10 trials were identified. A significant reduction in the risk of postoperative atrial fibrillation was found with a relative risk of 0.53 (95% confidence interval, 0.42 to 0.67) and a number needed-to-treat of 8.5 (95% confidence interval, 6.4 to 13.3). Amiodarone was found to be the most effective prophylactic agent with a relative risk of 0.32 (95% confidence interval, 0.19 to 0.50) and a number needed-to-treat of 4.8 (95% confidence interval, 3.7 to 7.6) and regarded as safe, with no severe adverse events registered. The risk of atrial fibrillation was overall reduced from 25.1% to 13.4% (p < 0.001) and for amiodarone as a single therapy from 30.4% to 9.6% (p < 0.001).
CONCLUSIONS
Medical prophylaxis with calcium-channel blockers, magnesium sulfate, or amiodarone significantly reduces the risk of developing atrial fibrillation after lung reduction surgery. However, amiodarone and magnesium sulfate were the most effective and safest drugs causing no increased risk of adverse events.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Humans; Pneumonectomy; Postoperative Complications; Risk Factors
PubMed: 25283696
DOI: 10.1016/j.athoracsur.2014.06.069 -
Endocrine-related Cancer Jul 2019Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To...
Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To provide a comprehensive guidance for clinicians, the etiology, pathogenesis, diagnosis and treatment of this challenging setting were systematically reviewed. According to literatures available, the etiologies of thyrotoxicosis with concomitant thyroid cancer were categorized into Graves' disease with concurrent differentiated thyroid cancer (DTC) or medullary thyroid cancer, Marine-Lenhart Syndrome with coexisting DTC, Plummer's disease with concomitant DTC, amiodarone-induced thyrotoxicosis with concomitant DTC, central hyperthyroidism with coexisting DTC, hyperfunctioning metastases of DTC and others. The underlying causal mechanisms linking thyrotoxicosis and thyroid cancer were elucidated. Medical history, biochemical assessments, radioiodine uptake, anatomic and metabolic imaging and ultrasonography-guided fine-needle aspiration combined with pathological examinations were found to be critical for precise diagnosis. Surgery remains a mainstay in both tumor elimination and control of thyrotoxicosis, while anti-thyroid drugs, beta-blockers, 131I, glucocorticoids, plasmapheresis, somatostatin analogs, dopamine agonists, radiation therapy, chemotherapy and tyrosine kinase inhibitors should also be appropriately utilized as needed.
Topics: Combined Modality Therapy; Diagnosis, Differential; Disease Management; Humans; Hyperthyroidism; Thyroid Neoplasms; Thyroidectomy; Thyrotoxicosis
PubMed: 31026810
DOI: 10.1530/ERC-19-0129 -
Cardiovascular Drugs and Therapy Feb 2024The available evidence to determine which antidysrhythmic drug is superior for pharmacologic cardioversion of recent-onset (onset within 48 h) atrial fibrillation (AF)... (Review)
Review
Safety and Effectiveness of Antidysrhythmic Drugs for Pharmacologic Cardioversion of Recent-Onset Atrial Fibrillation: a Systematic Review and Bayesian Network Meta-analysis.
PURPOSE
The available evidence to determine which antidysrhythmic drug is superior for pharmacologic cardioversion of recent-onset (onset within 48 h) atrial fibrillation (AF) is uncertain. We aimed to identify the safest and most effective agent for pharmacologic cardioversion of recent-onset AF in the emergency department.
METHODS
We searched MEDLINE, Embase, and Web of Science from inception to February 21, 2023 (PROSPERO: CRD42018083781). Eligible studies were randomized controlled trials that enrolled adult participants with AF ≤ 48 h, compared a guideline-recommended antidysrhythmic drug with another antidysrhythmic drug or a different formulation of the same drug or placebo and reported specific adverse events. The primary outcome was immediate, serious adverse event - cardiac arrest, sustained ventricular tachydysrhythmia, atrial flutter 1:1 atrioventricular conduction, hypotension, and bradycardia. Additional analyses included the outcomes of conversion to sinus rhythm within 4 h and 24 h. We extracted data according to PRISMA-NMA and appraised trials using Cochrane RoB 2. We performed Bayesian network meta-analysis (NMA) using a Markov Chain Monte Carlo method with random-effect model and vague prior distribution to calculate odds ratios with 95% credible intervals. We assessed confidence using CINeMA. We used surface under the cumulative ranking curve (SUCRA) to rank agent(s).
RESULTS
The systematic review initially identified 5545 studies. Twenty-five studies met eligibility criteria, and 22 studies (n = 3082) provided data for NMA, which demonstrated that vernakalant (SUCRA = 70.9%) is most likely to be safest. Additional effectiveness NMA demonstrated that flecainide (SUCRA = 89.0%) is most likely to be superior for conversion within 4 h (27 studies; n = 2681), and ranolazine-amiodarone IV (SUCRA 93.7%) is most likely to be superior for conversion within 24 h (24 studies; n = 3213). Confidence in the NMA estimates is variable and limited mostly by within-study bias and imprecision.
CONCLUSIONS
Among guideline-recommended antidysrhythmic drugs, the combination of digoxin IV and amiodarone IV is definitely among the least safe for cardioversion of recent onset AF; flecainide, vernakalant, ibutilide, propafenone, and amiodarone IV are definitely among the most effective for cardioversion within 4 h; flecainide is definitely among the most effective for cardioversion within 24 h. Further, randomized controlled trials with predetermined and strictly defined, hemodynamic adverse event outcomes are recommended.
PubMed: 38324103
DOI: 10.1007/s10557-024-07552-6 -
The American Journal of Emergency... Oct 2020Although available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Although available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some studies have shown that the rate of hospital admission is higher with amiodarone or lidocaine than with placebo. To study the effects of antiarrhythmic drugs during cardiac arrest, a meta-analysis was conducted to assess the efficacy of amiodarone and/or lidocaine.
METHODS
We searched studies from inception until Jan 21, 2020. The primary endpoint was survival to hospital discharge in cardiac arrest, and the secondary endpoints were survival to hospital admission/24 h and favorable neurological outcome.
RESULTS
A total of 9 studies were included. In head-to-head studies, amiodarone (odds ratio [OR] 2.96, 95% credible interval [CrI] 1.02-8.53) and lidocaine (OR 3.12, 95% CrI 1.08-9.98) had superior effects on survival to hospital admission/24 h compared to the combination of the two drugs. In terms of survival to hospital discharge, amiodarone (OR 1.18, 95% CrI 1.03-1.35) and lidocaine (OR 1.22, 95% CrI 1.06-1.41) were more effective than placebo. Amiodarone (OR 1.20, 95% CrI 1.02-1.41) was significantly better than placebo in favorable neurological outcome. However, there was no significant difference in other pairwise comparisons. The surface under cumulative ranking curve (SUCRA) revealed that lidocaine was the most effective therapy for survival to hospital admission (84.1%) and discharge (88.4%), while amiodarone was associated with a more favorable neurological outcome (88.2%).
CONCLUSIONS
Lidocaine had the best effect on both survival to hospital admission and discharge, while amiodarone was associated with a more favorable neurological outcome.
TRIAL REGISTRATION
This study is registered with PROSPERO, number CRD42020171049.
Topics: Amiodarone; Anti-Arrhythmia Agents; Bayes Theorem; Heart Arrest; Humans; Lidocaine; Network Meta-Analysis; Survival Analysis
PubMed: 33071078
DOI: 10.1016/j.ajem.2020.06.074