Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior myocardial infarction.

Abstract

OBJECTIVES:

The aim of this study was to determine whether the use of amiodarone in patients with atrial fibrillation (AF) increases the risk of bradyarrhythmia requiring a permanent pacemaker.

BACKGROUND:

Reports of severe bradyarrhythmia during amiodarone therapy are infrequent and limited to studies assessing the therapy's use in the management of patients with ventricular arrhythmias.

METHODS:

A study cohort of 8,770 patients age > or =65 years with a new diagnosis of AF was identified from a provincewide database of Quebec residents with a myocardial infarction (MI) between 1991 and 1999. Using a nested case-control design, 477 cases of bradyarrhythmia requiring a permanent pacemaker were matched (1:4) to 1,908 controls. Multivariable logistic regression was used to estimate the odds ratio (OR) of pacemaker insertion associated with amiodarone use, controlling for baseline risk factors and exposure to sotalol, Class I antiarrhythmic agents, beta-blockers, calcium channel blockers, and digoxin.

RESULTS:

amiodarone use was associated with an increased risk of pacemaker insertion (OR: 2.14, 95% confidence interval [CI]: 1.30 to 3.54). This effect was modified by gender, with a greater risk in women versus men (OR: 3.86, 95% CI: 1.70 to 8.75 vs. OR: 1.52, 95% CI: 0.80 to 2.89). Digoxin was the only other medication associated with an increased risk of pacemaker insertion (OR: 1.78, 95% CI: 1.37 to 2.31).

CONCLUSIONS:

This study suggests that the use of amiodarone in elderly patients with AF and a previous MI increases the risk of bradyarrhythmia requiring a permanent pacemaker. The finding of an augmented risk of pacemaker insertion in elderly women receiving amiodarone requires further investigation.

• Authors: Vidal Essebag, Tom Hadjis, Robert W Platt, Louise Pilote
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 41 Issue 2 Pg. 249-54 (Jan 15 2003) ISSN: 0735-1097 [Print] United States
• PMID: 12535818 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Arrhythmia Agents
• Amiodarone

Topics

• Aged
• Amiodarone (adverse effects, therapeutic use)
• Anti-Arrhythmia Agents (adverse effects, therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Bradycardia (chemically induced)
• Cardiac Pacing, Artificial
• Case-Control Studies
• Female
• Humans
• Male
• Myocardial Infarction (complications)
• Risk Factors
• Sex Factors