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Chronic amiodarone therapy impairs the function of the superior sinoatrial node in patients with atrial fibrillation.

Authors
 Hee-Sun Mun  ;  Changyu Shen  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Shien-Fong Lin  ;  Peng-Sheng Chen  ;  Boyoung Joung 
Citation
 CIRCULATION JOURNAL, Vol.77(9) : 2255-2263, 2013 
Journal Title
CIRCULATION JOURNAL
ISSN
 1346-9843 
Issue Date
2013
MeSH
Aged ; Amiodarone/adverse effects* ; Amiodarone/pharmacology ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/pathology* ; Atrial Fibrillation/physiopathology* ; Female ; Heart Atria/pathology ; Heart Atria/physiopathology ; Heart Rate/drug effects* ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sinoatrial Node*/pathology ; Sinoatrial Node*/physiopathology
Keywords
Aged ; Amiodarone/adverse effects* ; Amiodarone/pharmacology ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/pathology* ; Atrial Fibrillation/physiopathology* ; Female ; Heart Atria/pathology ; Heart Atria/physiopathology ; Heart Rate/drug effects* ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sinoatrial Node*/pathology ; Sinoatrial Node*/physiopathology
Abstract
BACKGROUND:
The mechanisms underlying amiodarone-induced sinoatrial node (SAN) dysfunction remain unclear, so we used 3-dimensional endocardial mapping of the right atrium (RA) to investigate.
METHODS AND RESULTS:
In a matched-cohort design, 18 patients taking amiodarone before atrial fibrillation (AF) ablation (amiodarone group) were matched for age, sex and type of AF with 18 patients who had undergone AF ablation without taking amiodarone (no-amiodarone group). The amiodarone group had a slower heart rate than the no-amiodarone group at baseline and during isoproterenol infusion. Only the amiodarone group had sick sinus syndrome (n=4, 22%, P=0.03) and abnormal (>550ms) corrected SAN recovery time (n=5, 29%; P=0.02). The median distance from the junction of the superior vena cava (SVC) and RA to the most cranial earliest activation site (EAS) was longer in the amiodarone group than in the no-amiodarone group at baseline (20.5 vs. 10.6mm, P=0.04) and during isoproterenol infusion (12.8 vs. 6.3mm, P=0.03). The distance from the SVC-RA junction to the EAS negatively correlated with the P-wave amplitudes of leads II (r=-0.47), III (r=-0.60) and aVF (r=-0.56) (P<0.001 for all).
CONCLUSIONS:
In a quarter of the AF patients, amiodarone causes superior SAN dysfunction, which results in a downward shift of the EAS and reduced P-wave amplitude in leads II, III and aVF at baseline and during isoproterenol infusion.
Files in This Item:
T201303201.pdf Download
DOI
10.1253/circj.CJ-12-1615
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Mun, Hee Sun(문희선)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87880
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