The incidence and predictors of overall adverse effects caused by low dose amiodarone in real-world clinical practice

BACKGROUND/AIMS: Most current knowledge regarding amiodarone toxicity derives from clinical trials. This study was performed to investigate the incidence and risk factors of overall adverse effects of amiodarone in real-world practice using a large sample size. METHODS: Between January 1, 2000 and March 10, 2012, a total of 930 consecutive patients who had been treated with amiodarone for arrhythmia were reviewed retrospectively. An amiodarone-associated adverse event was considered in cases of discontinuation or drug dose reduction due to an unexpected clinical response. RESULTS: The mean daily dose of amiodarone was 227 +/- 126 mg, and the mean duration was 490 +/- 812 days. During the mean follow-up duration of 982 +/- 1,137 days, a total of 154 patients (16.6%) experienced adverse effects related to amiodarone, the most common being bradycardia or conduction disturbance (9.5%). Major organ toxicities in the thyroid (2.5%), liver (2.2%), eyes (0.6%), and lungs (0.3%) were rare. All patients recovered fully without complications after amiodarone discontinuation or dose reduction. The only independent predictor of adverse effects was the duration of amiodarone treatment (odds ratio, 1.21; 95% confidence interval, 1.03 to 1.41; p = 0.016, per year). CONCLUSIONS: Low-dose amiodarone is well tolerated in a real-world clinical population. Further studies with a prospective design are needed to confirm this finding.

Complete Atrioventricular Block Secondary to Bortezomib Use in Multiple Myeloma

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.

Complete Atrioventricular Block Secondary to Bortezomib Use in Multiple Myeloma

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.

Bloqueio atrioventricular total experimental em cães: observação por tempo prolongado / Experimental complete heart block in dogs: long-term folow-up

Fundamento: O bloqueio atrioventricular (BAVT) induzido experimentalmente é um método de indução de bradicardia estável e permanente em estudos nos quais situações de baixa frequência cardíaca são exigidas. Objetivos: Apresentar os resultados da técnica de indução e acompanhamento de BAVT experimental em cães, por tempo prolongado. Casuística e Método: O BAVT foi induzido cirurgicamente em 64 cães de raça mestiça, com peso médio de 12,84 + - 4 kg, sob anestesia geral com thionembutal sódico (25 mg/kg) e analgesia com fentanil e droperidol. A técnica consistiu de injeção de formol a 40 por cento na região do nó atrioventricular, no feixe de Hiss ou em seus ramos, sem atriotomia. O eletrocardiograma foi usado durante o procedimento e mensalmente para controle. Doze animais foram seguidos por tempo prolongado. Os cães foram sacrificados por meio de aprofumdamento anestésico. Após a morte, o coração dos animais foi retirado, fixado...