Vol.7, No 1, 2000 pp. 76 -80
UC 612.17;611.12
AMIODARONE FOR CONVERSION OF PAROXYSMAL ATRIAL FIBRILLATION IN CONGESTIVE HEART FAILURE
Goran Koraćević, Sladjana Andrejević, Svetlana Nagorni, Dejan Sakač,
Radivoj Kocić, Snežana Ćirić, Aleksandar Stojković
Department  for Cardiovascular Diseases, Clinical Center, Niš, Yugoslavia
Summary. Congestive heart failure (CHF) is one of the leading causes of atrial fibrillation (AF), because it increases risk of AF 5 times. Approximately one fifth of CHF patients has AF, which impedes hemodynamic status, increases risk for both stroke and mortality. Conversion of AF to sinus rhythm partially alleviates bad prognosis. The opposite is also true, because in CHF patients AF increases risk of stroke; it may be considered that AF and CHF make one another substantially worse. Critical analysis of published studies and articles suggests amiodarone for the drug of choice for conversion of AF in patients with CHF, due to safety and efficacy, incl. minimal negative inotropic and proarrhytmic effect. We analyzed 20 hospitalized patients with paroxysmal (< 48h) AF and CHF (mostly due to coronary artery disease and hypertension). Amiodarone was applied in loading doses (800 - 1200 mg daily). Oral anticoagulant therapy with warfarin was "overlapped" with low - molecular- weight heparin (LMWH) Fraxarin, and for this purpose LMWH is superior to standard heparin, according to our experience. At discharge, 18 patients (90%) were in sinus rhythm, with average time to conversion 6.1 ? 3.8 days. One month later the percentage increased to 95%, because one another patient was converted. In all patients the reduction of heart rate was evident. Following unwanted effects were found: often increased QTc interval (without ventricular tachycardias of torsade type), first degree AV block in 4 patients, and especially difficulties in maintaining optimal range of warfarin efficacy, with INR increases up to 5, but without manifest bleedings. Literature data and our own experience for many years led us to conclusion that amiodarone is the drug of choice for medicament conversion of paroxysmal atrial fibrillation in sinus rhythm in patients with congestive heart failure.
Key words: Amiodarone, congestive heart failure, atrial fibrillation
AMIODARON U KONVERZIJI PAROKSIZMALNE ATRIJALNE FIBRILACIJE
U SRČANOJ INSUFICIJENCIJI

Kratak sadržaj: Kongestivna srčana insuficijencija (SI) je jedan od vodećih uzroka atrijalne fibrilacije (AF), jer oko 5 puta povećava rizik za AF. Približno svaki peti bolesnik sa SI ima i AF, koja pogoršava hemodinamski status, povećavajući i rizik za CVI i mortalitet. Konverzija AF u sinusni ritam donekle ublažava lošu prognozu. Kako važi i obratno, jer  SI u AF takodje povećava opasnost od  CVI, može se konstatovati da se SI i AF uzajamno znatno pogoršavaju. Kritična analiza publikovanih studija i pregleda sugeriše amiodaron kao lek izbora za konverziju AF u SI, zbog efikasnosti i bezbednosti, uklj. minimalno negativno inotropno i proaritmijsko dejstvo. Analizovali smo 20 hospitalizovanih pacijenta sa paroksizmalnom (< 48 h) AF i SI (uglavnom usled koronarne bolesti i hipertenzije). Amiodaron je primenjen u dozama uvodjenja (800?1200 mg dnevno). Oralna antikoagulantna terapija varfarinom je "preklopljena" sa niskomolekulskim heparinom (Fraxarin), za šta je pogodniji od standardnog heparina, prema našem iskustvu. U sinusnom ritmu je pri otpustu bilo 18 bolesnika (90%), sa prosečnim vremenom do konverzije 6.1 ? 3.8 dana. Mesec kasnije se procenat popeo na 95%, jer je još jedan pacijent konvertovan. U svih bolesnika je bila evidentna redukcija frekvence. Od neželjenih efekata amiodarona registovali smo česta produženja QTc intervala (bez ventrikularnih tahikardija tipa torsade), AV blok prvog stepena u 4 bolesnika, a naročito otežano postizanje željenog raspona efikasnosti varfarina, sa rastom INR-a do 5, ali bez manifesnih krvarenja. Na osnovu podataka iz literature i sopstvenog višegodišnjeg iskustva zaključujemo da je amiodaron najbolji izbor za medikamentnu konverziju paroksizmalne atrijalne fibrilacije u sinusni ritam u pacijenata sa srčanom insuficijencijom.
Ključne reči: Amiodaron, atrijalna fibrilacija, srčana insuficijencija