From the Guidelines
Amiodarone is effective for treating atrial flutter, particularly in patients with symptomatic, recurrent atrial flutter and underlying heart disease or comorbidities, as recommended by the 2015 ACC/AHA/HRS guideline 1. Amiodarone works by slowing electrical conduction through the heart tissue and prolonging the refractory period, which helps convert atrial flutter to normal sinus rhythm and prevents recurrence.
- The 2015 ACC/AHA/HRS guideline recommends amiodarone as a useful drug to maintain sinus rhythm in patients with symptomatic, recurrent atrial flutter, with a class IIa recommendation and level of evidence B-R 1.
- Amiodarone has significant toxicities, so it is used only when other treatments are contraindicated or ineffective, particularly in patients with heart failure or significant underlying heart disease 1.
- For acute treatment, amiodarone is typically administered intravenously with a loading dose of 150 mg over 10 minutes, followed by 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours.
- For long-term management, oral amiodarone is usually started at 400-600 mg daily for 2-4 weeks, then reduced to 200-400 mg daily for maintenance.
- However, amiodarone has numerous potential side effects, including thyroid dysfunction, pulmonary toxicity, liver abnormalities, and corneal deposits, requiring regular monitoring of thyroid, liver, and pulmonary function, as noted in the 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines 1.
- The SAFE-T trial demonstrated that amiodarone is effective in converting persistent AF to sinus rhythm and preventing recurrence, with a median time to recurrence of 487 days, compared to 74 days with sotalol and 6 days with placebo 1.
From the Research
Efficacy of Amiodarone in Treating Atrial Flutter
- Amiodarone is effective for long-term maintenance of sinus rhythm after electrical cardioversion of refractory atrial fibrillation or flutter 2.
- The drug has been shown to convert refractory atrial fibrillation or flutter to sinus rhythm, with conversion related to increased desethylamiodarone plasma levels and concomitant treatment with verapamil 2.
- Amiodarone is highly effective in maintaining sinus rhythm in patients with paroxysmal atrial fibrillation and plays a crucial role in preventing a range of ventricular arrhythmias 3.
Safety and Side Effects
- Amiodarone has been found to be safe and well-tolerated in patients with both normal and impaired left ventricular systolic function 4.
- However, the drug can cause adverse effects, including thyroid dysfunction, pulmonary fibrosis, and hepatic injury, necessitating regular follow-ups 5, 3.
- The most frequent adverse effects necessitating withdrawal from amiodarone therapy include skin discoloration, pulmonary fibrosis, and thyroid toxicity 6.
Clinical Use and Monitoring
- Amiodarone is an effective antiarrhythmic medication frequently used in practice for both ventricular and atrial arrhythmias 5.
- Clinicians should understand the indications, contraindications, dosing, side effects, and interactions of amiodarone to ensure safe and effective use 5, 3.
- Regular monitoring is recommended to manage potential side effects and interactions with other medications, such as warfarin, simvastatin, and atorvastatin 5.