Sex differences in the relationship between amiodarone use and the need for permanent pacing in patients with atrial fibrillation.

Abstract

BACKGROUND:

Amiodarone use was associated with an increased need for pacemaker insertion in a retrospective study of patients with atrial fibrillation (AF) and prior myocardial infarction. The aims of this study were to determine prospectively whether amiodarone increases the need for pacemakers in a general population of patients with AF and whether this effect is modified by sex.

METHODS:

The study included 1005 patients with new-onset AF who were enrolled in the Fibrillation Registry Assessing Costs, Therapies, Adverse events, and Lifestyle (FRACTAL). Multivariable Cox regression models, including time-dependent covariates accounting for medication exposure, were used to evaluate the risk of pacemaker insertion associated with amiodarone use.

RESULTS:

Amiodarone use was associated with an increased risk of pacemaker insertion (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.08-3.76) after adjustment for age, sex, atrial flutter, coronary artery disease, heart failure, and hypertension. The effect of amiodarone use was modified by sex, with a significant risk in women but not in men (HR, 4.69; 95% CI, 1.99-11.05 vs HR, 1.05; 95% CI, 0.42-2.58 [P = .02]). This interaction remained significant after adjustment for weight, body mass index, weight-adjusted amiodarone dose, and use of other antiarrhythmic or rate control drugs.

CONCLUSION:

The risk of bradyarrhythmia requiring pacemaker insertion associated with amiodarone use for AF is significantly greater in women than in men, independent of weight or body mass index.

• Authors: Vidal Essebag, Matthew R Reynolds, Tom Hadjis, Robert Lemery, Brian Olshansky, Alfred E Buxton, Mark E Josephson, Peter Zimetbaum
• Journal: Archives of internal medicine (Arch Intern Med) 2007 Aug 13-27 Vol. 167 Issue 15 Pg. 1648-53 ISSN: 0003-9926 [Print] United States
• PMID: 17698688 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Arrhythmia Agents
• Amiodarone

Topics

• Aged
• Amiodarone (therapeutic use)
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (therapy)
• Cardiac Pacing, Artificial (statistics & numerical data)
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Sex Factors