Author + information
- Received May 4, 2002
- Revision received July 30, 2002
- Accepted October 4, 2002
- Published online January 15, 2003.
- Vidal Essebag, MD, MSc, FRCP(C)*,* (, )
- Tom Hadjis, MD, MS, FRCP(C)*,
- Robert W Platt, PhD† and
- Louise Pilote, MD, MPH, PhD‡
- ↵*Reprint requests and correspondence:
Dr. Vidal Essebag, 3600 Parc Avenue #1203, Montreal, Quebec H2X 3R2, Canada.
Objectives The aim of this study was to determine whether the use of amiodarone in patients with atrial fibrillation (AF) increases the risk of bradyarrhythmia requiring a permanent pacemaker.
Background Reports of severe bradyarrhythmia during amiodarone therapy are infrequent and limited to studies assessing the therapy’s use in the management of patients with ventricular arrhythmias.
Methods A study cohort of 8,770 patients age ≥65 years with a new diagnosis of AF was identified from a provincewide database of Quebec residents with a myocardial infarction (MI) between 1991 and 1999. Using a nested case-control design, 477 cases of bradyarrhythmia requiring a permanent pacemaker were matched (1:4) to 1,908 controls. Multivariable logistic regression was used to estimate the odds ratio (OR) of pacemaker insertion associated with amiodarone use, controlling for baseline risk factors and exposure to sotalol, Class I antiarrhythmic agents, beta-blockers, calcium channel blockers, and digoxin.
Results Amiodarone use was associated with an increased risk of pacemaker insertion (OR: 2.14, 95% confidence interval [CI]: 1.30 to 3.54). This effect was modified by gender, with a greater risk in women versus men (OR: 3.86, 95% CI: 1.70 to 8.75 vs. OR: 1.52, 95% CI: 0.80 to 2.89). Digoxin was the only other medication associated with an increased risk of pacemaker insertion (OR: 1.78, 95% CI: 1.37 to 2.31).
Conclusions This study suggests that the use of amiodarone in elderly patients with AF and a previous MI increases the risk of bradyarrhythmia requiring a permanent pacemaker. The finding of an augmented risk of pacemaker insertion in elderly women receiving amiodarone requires further investigation.
☆ Dr. Louise Pilote and Dr. Robert Platt are recipients of Investigator Awards from the Canadian Institutes of Health Research (CIHR). This study was supported in part by a grant from the Fonds de la Recherche en Santé du Québec (FRSQ), No. 004001-104.
- Received May 4, 2002.
- Revision received July 30, 2002.
- Accepted October 4, 2002.
- American College of Cardiology Foundation