Modeling of Amiodarone Effect on Heart Rate Control in Critically Ill Patients With Atrial Tachyarrhythmias

Atrial Fibrillation Clinical Trial

— AMIRA  

Official title:

Modeling of Amiodarone Effect on Heart Rate Control in Critically Ill Patients With Atrial Tachyarrhythmias

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03413150
• Other study ID #: CIC1421-17-13
• Status: Completed
• Start date: January 2007
• Est. completion date: April 2012

Study information

• Verified date: September 2019
• Source: Groupe Hospitalier Pitie-Salpetriere
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Aims Amiodarone is the gold-standard medication to control heart rate in critically ill patients with atrial tachyarrhythmias (ATs); however, effective doses and covariates influencing its efficacy remain unknown. The investigators therefore performed pharmacodynamic modeling of heart rate reduction induced by amiodarone in these patients. Methods and Results This observational study included 80 consecutive severely ill patients receiving amiodarone to treat ATs. A total of 1348 time-heart rate observations with 361 amiodarone dose administrations were analyzed during a period of up to 6 days after hospital treatment initiation using a nonlinear mixed-effect model. Pretreatment with amiodarone before intensive care administration, paroxysmal versus persistent AT, catecholamine infusion, and fluid and magnesium loading were among the covariates assessed in the model. In case of paroxysmal AT in a patient not pretreated with amiodarone, a 300 mg intravenous loading dose combined with an 800 mg oral dose on the first day, followed by 800 mg/day orally for 4 days was effective in achieving a heart rate between 80 and 115 bpm within the first day, and to maintain it during the next 4 days. Corresponding doses were twice as high in patients with persistent AT. Use of intravenous magnesium (p\0.02) and fluid loading (p\0.02) was associated with an earlier and greater heart rate decrease, while use of dobutamine had an opposite influence (p\0.05). Conclusions In critically ill patients with AT, the dose of amiodarone required to control heart rate is influenced by the type of AT and by other easily measurable conditions which may allow better individualization of amiodarone dosing.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 80
• Est. completion date: April 2012
• Est. primary completion date: April 2012
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• critically ill patients who had received at least one dose of amiodarone to treat or prevent AT during their hospitalization in the ICU.

Exclusion Criteria:

• Patients with paced rhythm or incomplete charts were excluded

Related Conditions & MeSH terms

• Atrial Fibrillation
• Atrial Tachycardia
• Tachycardia

Intervention

Drug:
• Amiodarone
Data were extracted from the files of 80 consecutive critically ill patients who had received at least one dose of amiodarone to treat or prevent AT during their hospitalization in the ICU.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Groupe Hospitalier Pitie-Salpetriere

References & Publications (44)

Anastasiou-Nana M, Levis GM, Moulopoulos S. Pharmacokinetics of amiodarone after intravenous and oral administration. Int J Clin Pharmacol Ther Toxicol. 1982 Nov;20(11):524-9. — View Citation

Artucio H, Pereira M. Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med. 1990 Dec;18(12):1383-8. — View Citation

Brodsky MA, Allen BJ, Walker CJ 3rd, Casey TP, Luckett CR, Henry WL. Amiodarone for maintenance of sinus rhythm after conversion of atrial fibrillation in the setting of a dilated left atrium. Am J Cardiol. 1987 Sep 1;60(7):572-5. — View Citation

Butterworth J. Dobutamine: too dangerous for "routine" administration? Anesthesiology. 2008 Jun;108(6):973-4. doi: 10.1097/ALN.0b013e318172fb98. — View Citation

Carlsson J, Miketic S, Windeler J, Cuneo A, Haun S, Micus S, Walter S, Tebbe U; STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. — View Citation

Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA. Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias. Am J Cardiol. 1998 Mar 1;81(5):594-8. — View Citation

Deharo JC, Durand A, Macaluso G, Malaterre H, Le Tallec L, Panagides D, Bory M, Djiane P. Clinical electrophysiologic effects of a single high oral dose of amiodarone. Fundam Clin Pharmacol. 1997;11(3):275-80. — View Citation

Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M, Siostrzonek P, Heinz G. Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med. 2001 Jun;29(6):1149-53. — View Citation

Donaldson L, Grant IS, Naysmith MR, Thomas JS. Acute amiodarone-induced lung toxicity. Intensive Care Med. 1998 Jun;24(6):626-30. — View Citation

European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna — View Citation

Evans SJ, Myers M, Zaher C, Simonson J, Nalos P, Vaughn C, Oseran D, Gang E, Peter T, Mandel W. High dose oral amiodarone loading: electrophysiologic effects and clinical tolerance. J Am Coll Cardiol. 1992 Jan;19(1):169-73. — View Citation

Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A. Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome: propensity-adjusted analyses. Anesthesiology. 2008 Jun;108(6):979-87. doi: 10.1097/ALN.0b013e318173026f. — View Citation

Galve E, Rius T, Ballester R, Artaza MA, Arnau JM, García-Dorado D, Soler-Soler J. Intravenous amiodarone in treatment of recent-onset atrial fibrillation: results of a randomized, controlled study. J Am Coll Cardiol. 1996 Apr;27(5):1079-82. — View Citation

Greenberg ML, Lerman BB, Shipe JR, Kaiser DL, DiMarco JP. Relation between amiodarone and desethylamiodarone plasma concentrations and electrophysiologic effects, efficacy and toxicity. J Am Coll Cardiol. 1987 May;9(5):1148-55. — View Citation

Hainsworth R. Reflexes from the heart. Physiol Rev. 1991 Jul;71(3):617-58. Review. — View Citation

Harris L, Hind CR, McKenna WJ, Savage C, Krikler SJ, Storey GC, Holt DW. Renal elimination of amiodarone and its desethyl metabolite. Postgrad Med J. 1983 Jul;59(693):440-2. — View Citation

Jacqmin P, Snoeck E, van Schaick EA, Gieschke R, Pillai P, Steimer JL, Girard P. Modelling response time profiles in the absence of drug concentrations: definition and performance evaluation of the K-PD model. J Pharmacokinet Pharmacodyn. 2007 Feb;34(1):5 — View Citation

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the manageme — View Citation

Kanji S, Williamson DR, Yaghchi BM, Albert M, McIntyre L; Canadian Critical Care Trials Group. Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients. J Crit Care. 2012 Jun;27(3):326.e1-8. — View Citation

Kochiadakis GE, Igoumenidis NE, Parthenakis FI, Chlouverakis GI, Vardas PE. Amiodarone versus propafenone for conversion of chronic atrial fibrillation: results of a randomized, controlled study. J Am Coll Cardiol. 1999 Mar 15;33(4):966-71. — View Citation

Kochiadakis GE, Igoumenidis NE, Solomou MC, Kaleboubas MD, Chlouverakis GI, Vardas PE. Efficacy of amiodarone for the termination of persistent atrial fibrillation. Am J Cardiol. 1999 Jan 1;83(1):58-61. — View Citation

Kumar A. Intravenous amiodarone for therapy of atrial fibrillation and flutter in critically ill patients with severely depressed left ventricular function. South Med J. 1996 Aug;89(8):779-85. — View Citation

Lafont E, Urien S, Salem JE, Heming N, Faisy C. Modeling for critically ill patients: An introduction for beginners. J Crit Care. 2015 Dec;30(6):1287-94. doi: 10.1016/j.jcrc.2015.09.002. Epub 2015 Sep 4. — View Citation

Lotto A, Satolli R, Baldini MR. Hemodynamic effects of amiodarone. Circulation. 1980 Sep;62(3):666. — View Citation

Mayr A, Knotzer H, Mutz N, Hasibeder W. Atrial tachyarrhythmia after cardiac surgery. Intensive Care Med. 1999 Feb;25(2):242-3. — View Citation

Mayr A, Ritsch N, Knotzer H, Dünser M, Schobersberger W, Ulmer H, Mutz N, Hasibeder W. Effectiveness of direct-current cardioversion for treatment of supraventricular tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients — View Citation

Miller S, Crystal E, Garfinkle M, Lau C, Lashevsky I, Connolly SJ. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis. Heart. 2005 May;91(5):618-23. Review. — View Citation

Nerheim P, Birger-Botkin S, Piracha L, Olshansky B. Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia. Circulation. 2004 Jul 20;110(3):247-52. Epub 2004 Jun 28. — View Citation

Nicot F, Procopi N, Nguyen LS. Intravenous amiodarone-induced acute liver failure in cardiac surgery intensive care unit. Therapie. 2018 Sep;73(4):355-357. doi: 10.1016/j.therap.2017.12.007. Epub 2017 Dec 30. — View Citation

Packer DL, Bardy GH, Worley SJ, Smith MS, Cobb FR, Coleman RE, Gallagher JJ, German LD. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol. 1986 Mar 1;57(8):563-70. — View Citation

Papiris SA, Triantafillidou C, Kolilekas L, Markoulaki D, Manali ED. Amiodarone: review of pulmonary effects and toxicity. Drug Saf. 2010 Jul 1;33(7):539-58. doi: 10.2165/11532320-000000000-00000. Review. — View Citation

Patsilinakos S, Christou A, Kafkas N, Nikolaou N, Antonatos D, Katsanos S, Spanodimos S, Babalis D. Effect of high doses of magnesium on converting ibutilide to a safe and more effective agent. Am J Cardiol. 2010 Sep 1;106(5):673-6. doi: 10.1016/j.amjcard — View Citation

Pourbaix S, Berger Y, Desager JP, Pacco M, Harvengt C. Absolute bioavailability of amiodarone in normal subjects. Clin Pharmacol Ther. 1985 Feb;37(2):118-23. — View Citation

Rätz Bravo AE, Drewe J, Schlienger RG, Krähenbühl S, Pargger H, Ummenhofer W. Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature. Crit Care Med. 2005 Jan;33(1):128-34; discussion 245-6. — View Citation

Remme WJ, Kruyssen HA, Look MP, van Hoogenhuyze DC, Krauss XH. Hemodynamic effects and tolerability of intravenous amiodarone in patients with impaired left ventricular function. Am Heart J. 1991 Jul;122(1 Pt 1):96-103. — View Citation

Salem JE, Dureau P, Funck-Brentano C, Hulot JS, El-Aissaoui M, Aissaoui N, Urien S, Faisy C. Effectiveness of heart rate control on hemodynamics in critically ill patients with atrial tachyarrhythmias managed by amiodarone. Pharmacol Res. 2017 Aug;122:118 — View Citation

Salem JE, El-Aissaoui M, Alazard M, Hulot JS, Aissaoui N, Le-Heuzey JY, Funck-Brentano C, Faisy C, Urien S. Modeling of Amiodarone Effect on Heart Rate Control in Critically Ill Patients with Atrial Tachyarrhythmias. Clin Pharmacokinet. 2016 Aug;55(8):991 — View Citation

Schwartz A, Shen E, Morady F, Gillespie K, Scheinman M, Chatterjee K. Hemodynamic effects of intravenous amiodarone in patients with depressed left ventricular function and recurrent ventricular tachycardia. Am Heart J. 1983 Oct;106(4 Pt 2):848-56. — View Citation

Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, Fletcher RD, Sharma SC, Atwood JE, Jacobson AK, Lewis HD Jr, Raisch DW, Ezekowitz MD; Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) Investigators. Amiodarone versus sotalol for atr — View Citation

Sticherling C, Behrens S, Kamke W, Stahn A, Zabel M. Comparison of acute and long-term effects of single-dose amiodarone and verapamil for the treatment of immediate recurrences of atrial fibrillation after transthoracic cardioversion. Europace. 2005 Nov; — View Citation

Tonet JL, Lechat P, Frank R, Lascault G, Fontaine G, Facquet J, Cohen A, Grosgogeat Y. [Electrocardiographic effects and antiarrhythmic action of 1200 mg of oral amiodarone per day]. Ann Cardiol Angeiol (Paris). 1984 Jul-Sep;33(5):309-15. French. — View Citation

Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, Said SA, Darmanata JI, Timmermans AJ, Tijssen JG, Crijns HJ; Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group. A comparison of rate control and rh — View Citation

Vardas PE, Kochiadakis GE, Igoumenidis NE, Tsatsakis AM, Simantirakis EN, Chlouverakis GI. Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation: a randomized, controlled study. Chest. 2000 Jun;117(6):1538-45. — View Citation

Vietti-Ramus G, Veglio F, Marchisio U, Burzio P, Latini R. Efficacy and safety of short intravenous amiodarone in supraventricular tachyarrhythmias. Int J Cardiol. 1992 Apr;35(1):77-85. — View Citation

* Note: There are 44 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Heart Rate	HR was retrieved from patients ICU charts	HR at 1rst administration of cordarone and then 4 to 6 times a day after each dosing until day 6 or death or ICU discharge