Role of amiodarone in the management of atrial arrhythmias in adult Fontan patients

Satoshi Kawada, Praloy Chakraborty, Lucy Roche, Erwin N. Oechslin, Candice Silversides, Rachel M. Wald, Eugene Downar, Louise Harris, Lorna Swan, Rafael Alonso-Gonzalez, Sara Thorne, Kenichiro Yamamura, Kumaraswamy Nanthakumar, Blandine Mondésert, Paul Khairy, Krishnakumar Nair

Research output: Contribution to journalArticlepeer-review

Abstract

Background Patients with Fontan circulation are known to be at high risk for developing atrial tachyarrhythmias (AAs). Our objective was to examine the efficacy and safety of amiodarone in the management of ATs in adult Fontan patients. Methods Primary outcomes of this single-centre, retrospective study included freedom from AAs and incidence of adverse effects of amiodarone on Fontan patients. Heart failure (HF) events and composite outcomes of death from any cause, Fontan revision and heart transplantation were evaluated as secondary outcomes. Predictors of HF and discontinuing amiodarone were also evaluated. Results A total of 61 patients (mean age 31.6±11.3 years, 40.9% female), who were treated with amiodarone in between 1995 and 2018, were included. AAs free survival at 1, 3 and 5 years were 76.2%, 56.9% and 30.6%, respectively. During a median follow-up of 50.5 months, 34 (55.7%) patients developed side effects, and 20 (32.8%) patients discontinued amiodarone due to side effects. Thyroid dysfunction was the most common side effect (n=26, 76.5%), amiodarone-induced thyrotoxicosis (AIT) (n=16, 27.1%) being most common thyroid dysfunction. Young age (age <28.5 years) was associated with discontinuing amiodarone (HR 5.50, 95% CI 1.19 to 25.4, p=0.029). AIT significantly increased risk of HF (HR 4.82, 95% CI 1.71 to 13.6, p=0.003). Conclusions Short-term efficacy of amiodarone in Fontan physiology is acceptable. However, long-term administration is associated with a reduction of efficacy and a significant prevalence of non-cardiac side effects. AIT is associated with exacerbation of HF. The judicious use of amiodarone administration should be considered in this population.

Original languageEnglish
Pages (from-to)1062-1068
Number of pages7
JournalHeart
Volume107
Issue number13
DOIs
Publication statusPublished - Jul 1 2021
Externally publishedYes

Keywords

  • atrial flutter
  • drug monitoring
  • fontan physiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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