From the Guidelines
Amiodarone is a reasonable option 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.
Key Points to Consider
- Amiodarone can be used to maintain sinus rhythm in patients with symptomatic, recurrent atrial flutter, with the choice of drug depending on underlying heart disease and comorbidities 1.
- The decision to use amiodarone should take into account its significant toxicities, and it is generally used only when other treatments are contraindicated or ineffective 1.
- Amiodarone has been shown to be effective in managing atrial arrhythmias, although much of the data has been derived from its use in patients with atrial fibrillation 1.
- Administration of amiodarone is reasonable, particularly in patients with heart failure or significant underlying heart disease 1.
Important Considerations for Use
- Amiodarone has a significant side effect profile, including thyroid dysfunction, pulmonary fibrosis, liver toxicity, and corneal deposits, necessitating regular monitoring 1.
- Amiodarone also has numerous drug interactions due to its metabolism through the cytochrome P450 system and can increase the levels of warfarin, digoxin, and many other medications 1.
Alternatives and Additional Therapies
- Other drugs such as dofetilide and sotalol can also be useful in maintaining sinus rhythm in patients with symptomatic, recurrent atrial flutter 1.
- Catheter ablation is a reasonable option for patients with CTI-dependent atrial flutter, particularly those who have developed atrial flutter while being treated with antiarrhythmic drugs for atrial fibrillation 1.
From the Research
Amiodarone for Atrial Flutter
- Amiodarone is an effective antiarrhythmic medication used for both ventricular and atrial arrhythmias, including atrial flutter 2, 3.
- It is considered a class III antiarrhythmic agent but also has class I, II, and IV actions, making it a unique and effective anti-arrhythmic agent 2.
- Amiodarone has been shown to be effective in maintaining sinus rhythm in patients with atrial flutter, with a moderate certainty of evidence 4.
- The drug has a low to negligible proarrhythmic action and does not aggravate heart failure, making it a safe option for patients with compromised ventricular function 5, 2.
Comparison with Other Treatments
- Amiodarone has been compared to other antiarrhythmic drugs, such as quinidine, ibutilide, and propafenone, in terms of efficacy in maintaining sinus rhythm in patients with atrial flutter 4.
- The results suggest that amiodarone is likely to result in a large increase in maintenance of sinus rhythm at hospital discharge or end of study follow-up, with a moderate certainty of evidence 4.
- Electrical cardioversion strategies for atrial flutter have also been shown to be highly effective, with a very low rate of mortality and stroke or systemic embolism 4.
Safety and Side Effects
- Amiodarone has several side effects, including thyroid abnormalities, pulmonary fibrosis, and transaminitis, for which routine monitoring is recommended 2, 3.
- The drug interacts with several medications, such as warfarin, simvastatin, and atorvastatin, and many HIV antiretroviral medications, which should be taken into account when prescribing amiodarone 2, 3.
- Despite the potential side effects, amiodarone is considered a safe option for patients with atrial flutter, especially those with compromised ventricular function 5, 2.