Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill

Mitric, Goran, Udy, Andrew, Bandeshe, Hiran, Clement, Pierre and Boots, Rob (2016) Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill. Critical Care, 20 1: . doi:10.1186/s13054-016-1252-2


Author Mitric, Goran
Udy, Andrew
Bandeshe, Hiran
Clement, Pierre
Boots, Rob
Title Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2016-04-02
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s13054-016-1252-2
Open Access Status DOI
Volume 20
Issue 1
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Background: Atrial fibrillation is a common rhythm disturbance in the general medical-surgical intensive care unit. Amiodarone is a popular drug in this setting but evidence to inform clinical practice remains scarce. We aimed to identify whether variation in the clinical use of amiodarone was associated with recurrent atrial fibrillation.

Methods: This was a retrospective audit of 177 critically ill patients who developed new-onset atrial fibrillation after admission to a tertiary level medical-surgical trauma intensive care unit. Patterns of amiodarone prescription (including dosage schedule and duration) were assessed in relation to recurrence of atrial fibrillation during the intensive care unit stay. Known recurrence risk factors, such as inotrope administration, cardiac disease indices, Charlson Comorbidity Index, magnesium concentrations, fluid balance, and potassium concentrations, were also included in adjusted analysis using forward stepwise logistic regression modelling.

Results: The cohort had a median (interquartile range) age of 69 years (60-75), Acute Physiology and Chronic Health Evalution II score of 22 (17-28) and Charlson Comorbidity Index of 2 (1-4). A bolus dose of amiodarone followed by infusion (P = 0.02), in addition to continuing amiodarone infusion through to discharge from the intensive care unit (P < 0.001), were associated with less recurrent dysrhythmia. Recurrence after successful treatment was associated with ceasing amiodarone while an inotrope infusion continued (P < 0.001), and was more common in patients with a prior history of congestive cardiac failure (P = 0.04), and a diagnosis of systemic inflammatory response syndrome (P = 0.02).

Conclusions: Amiodarone should be administered as a bolus dose followed immediately with an infusion when treating atrial fibrillation in the medical-surgical intensive care unit. Consideration should be given to continuing amiodarone infusions in patients on inotropes until they are ceased.
Keyword Amiodarone
Atrial fibrillation
Critical care
Recurrence
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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