Amiodarone and Torsade de Pointes
Authors: Ralph Lazzara
Journal: Annals of Internal Medicine (1989)

Editorials1 October 1989Amiodarone and Torsade de PointesRalph Lazzara, MDRalph Lazzara, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-7-549 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAmiodarone has been unique among antiarrhythmic agents introduced into the United States. Its clinical use has been almost entirely "compassionate use" as a last resort for life-threatening ventricular arrhythmias resistant to approved agents and often to other investigational agents. Placebo-controlled trials or simultaneous direct comparisons with standard agents did not take place before approval by the Food and Drug Administration (FDA) because they were not supported by the pharmaceutical industry. During this period of clinical use, amiodarone came to be considered to be so potent as to be in a class by itself in regard to therapeutic efficacy and in...References1. SinghVenkateshNademaneeJosephsonKannan BNKMR. The historical development, cellular electrophysiology and pharmacology of amiodarone. Prog Cardiovasc Dis. 1989;31:249-80. CrossrefMedlineGoogle Scholar2. Mason J. Amiodarone. N Engl JMed. 1987;316:455-65. CrossrefMedlineGoogle Scholar3. SinghVaughan Williams BE. The effect of amiodarone, a new anti anginal drug, on cardiac muscle. Br J Pharmacol. 1970;39:657-67. CrossrefMedlineGoogle Scholar4. MasonHondeghemKatzung JLB. Amiodarone blocks inactivated cardiac sodium channels. Pflugers Arch. 1983;396:79-85. CrossrefMedlineGoogle Scholar5. Vaughan Williams E. Classification of antiarrhythmic drugs. In: Sande E, Flensted-Jensen E, Olesen KH, eds. Symposium on Cardiac Arrhythmias. Sodertalje, Sweden: Astra; 1970:449-72. Google Scholar6. NattelTalajicQuantz SMM. Frequency-dependent effects of amiodarone on atrio-ventricular nodal function and slow-channel action potentials: evidence for calcium channel blocking activity. Circulation. 1987;76:442-9. CrossrefMedlineGoogle Scholar7. Neliat G. Effects of butoprozine on ionic currents in frog atrial and ferret ventricular fibers. Comparison with amiodarone and verapamil. Arch Int Pharcodyn Ther. 1982;255:237-55. MedlineGoogle Scholar8. PolsterBroekhuysen PJ. The adrenergic antagonism of amiodarone. Biochem Pharmacol. 1976;25:131-8. CrossrefMedlineGoogle Scholar9. BroekhuysenCharlierGhislain JRJ. Action of amiodarone on guinea-pig heart sodium and potassium-activated adenosine triphosphatase. Biochem Pharmacol. 1972;21:2951-60. CrossrefMedlineGoogle Scholar10. ChatelainFerrieraLaruel PJR. Amiodarone-induced modifications of the phospholipid physical state. A fluorescence polarization study. Biochem Pharmacol. 1986;35:3007-13. CrossrefMedlineGoogle Scholar11. JackmanFridayAndersonAliotClarkLazzara WKJEMR. The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Prog Cardiovasc Dis. 1988;31:115-72. CrossrefMedlineGoogle Scholar12. BrachmannScherlagRosenshtraukhLazzara JBLR. Bradycardia-dependent triggered activity: Relevance to drug-induced multiform ventricular tachycardia. Circulation. 1983;68:846-56. CrossrefMedlineGoogle Scholar13. ColatskyHogan TP. Effect of external calcium, calcium channel-blocking agents, and stimulation frequency on cycle length-dependent changes in canine cardiac action potential duration. Circ Res. 1980;46:543-52. CrossrefMedlineGoogle Scholar14. MattioniZheutlinDunningtonKehoe TTCR. The proar-rhythmic effects of amiodarone. Prog Cardiovasc Dis. 1989;31:439-46. CrossrefMedlineGoogle Scholar15. NguyenScheinmanSeger PMJ. Polymorphous ventricular tachycardia: clinical characteristics, therapy, and the QT interval. Circulation. 1986;74:340-9. CrossrefMedlineGoogle Scholar16. MattioniZheutlinSarmientoParkerLeschKehoe TTJMMR. The long-term safety and efficacy of amiodarone in patients with prior drug-mediated torsade de pointes. Ann Intern Med. 1989;111:574-80. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Ralph Lazzara, MDAffiliations: University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIUPHAR – invited review - Ibogaine – A legacy within the current renaissance of psychedelic therapyA case of congenital long QT syndrome, type 8, undergoing laparoscopic hysterectomy with general anesthesiaCardiac Arrhythmia and Device Management in Patients with CancerHave the Findings from Clinical Risk Prediction and Trials Any Key Messages for Safety Pharmacology?Sudden Cardiac Death and Disorders of the QT Interval: Anesthetic Implications and Focus on Perioperative ManagementDrug-associated arrhythmia in the military patientArrhythmiasCurrent Use of Domperidone and Co-prescribing of Medications that Increase Its Arrhythmogenic Potential Among Older Adults: A Population-Based Cohort Study in Ontario, CanadaMacrolide Antibiotics and the Risk of Cardiac ArrhythmiasDrug-induced long QT syndrome and fatal arrhythmias in the intensive care unitProarrhythmia (Secondary)QTc and Sudden Cardiac DeathQT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de PointesPredicting Drug‐Induced QT Prolongation and Torsades de Pointes: A Review of Preclinical Endpoint MeasuresDrug-induced QT interval prolongation: mechanisms and clinical managementThe electro-mechanical window in anaesthetized guinea pigs: a new marker in screening for Torsade de Pointes riskMetabolic syndrome potentiates the cardiac action potential-prolonging action of drugs: A possible 'anti-proarrhythmic' role for amlodipinePredicting the degree of drug-induced QT prolongation and the risk for torsades de pointeshERG Potassium Channels in Drug Discovery and DevelopmentDrug-Induced Long QT SyndromeDrug-Induced ArrhythmiaAntiarrhythmic therapy in atrial fibrillationPrevention of Torsade de Pointes in Hospital SettingsPrevention of Torsade de Pointes in Hospital SettingsClinically relevant QTc prolongation due to overridden drug-drug interaction alerts: a retrospective cohort studyRHYTHM DISORDERSPreclinical Torsades-de-Pointes Screens: Advantages and limitations of surrogate and direct approaches in evaluating proarrhythmic riskEffects of pink grapefruit juice on QT variability in patients with dilated or hypertensive cardiomyopathy and in healthy subjectsUnderstanding drug-induced torsades de pointes: a genetic stanceThe canine virtual ventricular wall: A platform for dissecting pharmacological effects on propagation and arrhythmogenesisLe syndrome du QT longFurther evidence of inherited long QT syndrome gene mutations in antiarrhythmic drug–associated torsades de pointesManagement of Cardiac ArrhythmiasSudden Cardiac DeathAntiarrhythmic DrugsDrug-induced long QT and torsade de pointes: recent advancesLong QT syndrome: reduced repolarization reserve and the genetic linkDrug-induced proarrhythmia and use of QTc-prolonging agents: Clues for cliniciansDrug-induced torsades de pointes: The evolving role of pharmacogeneticsRefining detection of drug-induced proarrhythmia: QT interval and TRIaDOther Cardioactive AgentsDrug-Induced Prolongation of the QT IntervalPre-Clinical Assessment of Drug-Induced QT Interval Prolongation. Current Issues and Impact on Drug DiscoveryArrhythmia TherapyElectrophysiological effects of dronedarone (SR 33589), a noniodinated amiodarone derivative in the canine heart: comparison with amiodaroneMANAGEMENT OF ARRHYTHMIASDrug Interactions with CisaprideMolecular Genetics of the Acquired Long QT SyndromePolymorphic Ventricular Tachycardia and Long QT SyndromesInherited Long QT Syndromes:.Pro: All patients should receive pharmacologic prophylaxis for atrial fibrillation after cardiac surgeryAmiodarone reduces transmural heterogeneity of repolarization in the human heartMechanisms and management of proarrhythmiaImpact of structural heart disease on the selection of class III antiarrhythmics for the prevention of atrial fibrillation and flutterComparison of the acute cardiotoxicity of the antimalarial drug halofantrine in vitro and in vivo in anaesthetized guinea-pigsAntiarrhythmic agents: Current status and perspectivesA practical approach to torsade de pointesDifferential Electrophysiologic Effects of Chronically Administered Amiodarone on Canine Purkinje Fibers versus Ventricular MuscleEffects of Long-term Oral Administration of Amiodarone on the Ventricular Repolarization of Rabbit HeartsBasic Concepts in Cellular Cardiac Electrophysiology: Part II: Block of Ion Channels by Antiarrhythmic DrugsElectrophysiologic Mechanisms of the Long QT Interval Syndromes and Torsade de PointesHanno L. Tan, MD, PhD, Charles J. Y. Hou, MD, Michael R. Lauer, MD, PhD, and Ruey J. Sung, MDTorsade de pointesFrequency-dependent electrophysiologic effects of amiodarone in humans.Rate-corrected QT interval: Techniques and limitationsAmiodarone and post-MI patients.Effects of Amiodarone and Bepridil on Ventricular Depolarization and RepolarizationReverse use-dependent effects of sotalol demonstrated by recording monophasic action potentials of the right ventricleAmiodarone-induced torsades de pointes: the possible facilitatory role of digoxinPolymorphous ventricular tachycardia associated with acute myocardial infarction.Suppression of time-dependent outward current in guinea pig ventricular myocytes. Actions of quinidine and amiodarone.Rate dependence of sotalol-induced prolongation of ventricular repolarization during exercise in humans.Channel specificity in antiarrhythmic drug action. Mechanism of potassium channel block and its role in suppressing and aggravating cardiac arrhythmias.Effects of bepridil and diltiazem on ventricular repolarization in angina pectorisProarrhythmia 1 October 1989Volume 111, Issue 7Page: 549-551KeywordsArrhythmiaCardiology and cardiovascular diseasesCardiovascular therapyFood and Drug Administration ePublished: 1 December 2008 Issue Published: 1 October 1989 PDF downloadLoading ...