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Background: Amiodarone is the most effective antiarrhythmic agent for the treatment of atrial fibrillation (AF) but its use is limited by side effects related to the cumulative drug exposure. Protocol driven down titration is not commonly employed. We sought to demonstrate the effectiveness and safety of such a strategy.
Methods: There were 124 (70 males, 54 female) consecutive patients in a single cardiology practice deemed eligible for amiodarone therapy for AF management evaluated. Seventy-two patients (58%) had implanted devices (29 IPG, 24 ICD,17 CRTD, and 2 insertable loop recorders). Patients were routinely followed every 6 months. During down titration patients were assessed by remote monitoring if they had implantable devices. Successful control of AF was defined as AF burden <1% at last follow-up on implantable device patients or lack of symptoms and normal sinus rhythm on last holter monitor or routine 12 lead electrocardiogram on non-device patients.
Results: Ninety-five (77%) patients(52m,43F, aged 33-102 years, median 80) with a median follow-up of 46 months (6-130) had effective control of AF. No deaths, hospitalizations or late cardioversions occurred related to amiodarone. 4 patients with ineffective AF control had transient non-cardiac side effects that resolved. Figure 1 shows the effective weekly Amiodarone dose (mg) of these 95 patients.
Conclusions: AF can be controlled in most patients using a forced down titration monitoring protocol with rare side effects over a long follow-up.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Fibrillatory Arrhythmias: Outcomes With Contemporary Practice
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1110-108
- 2017 American College of Cardiology Foundation