title: Role of amiodarone on the systemic inflammatory response induced by cardiac surgery: proinflammatory actions.
abstract: OBJECTIVE
  Amiodarone (AMIO), a widely used anti-arrhythmic drug, has been shown to reduce the incidence of atrial fibrillation after cardiac surgery and also to exert immunomodulatory actions in vitro and proinflammatory effects in vivo. The present study investigated the immunomodulatory properties of AMIO in the inflammatory response induced by cardiac surgery with cardiopulmonary bypass (CPB).
  
  
  METHODS
  In this double-blind, placebo-controlled trial, 20 patients undergoing elective coronary artery bypass graft were randomized to receive placebo or AMIO 600 mg day(-1) orally for seven days before surgery and 45 mg hr(-1) intravenously for 48 hr postoperatively. Plasma levels of the proinflammatory markers C-reactive protein (CRP), fibrinogen (FBG), tumour necrosis factor (TNF)-alpha, interleukin (IL)-6 and monocyte chemoattractant protein (MCP)-1, and the antiinflammatory marker IL-10, were compared before and after surgery.
  
  
  RESULTS
  Ninety-six hours after start of surgery, plasma levels of FBG had more than doubled (2.2 +/- 0.5-fold increase, P < 0.0001). Overall, FBG formation was significantly increased in the AMIO group (P = 0.048). Monocyte chemoattractant protein 1 secretion transiently increased four hours after start of surgery (6.6 +/- 4.5-fold increase) but rapidly declined thereafter, (P < 0.0001). There was a trend toward higher MCP-1 plasma concentrations in the AMIO group (P = 0.13). The plasma levels of CRP, TNF-alpha, IL-6 and Il-10 changed significantly over time, but were not altered by AMIO treatment.
  
  
  CONCLUSIONS
  In the inflammatory response induced by cardiac surgery with CPB, our data suggest that AMIO treatment is associated with a selective trend toward proinflammatory actions.
authors.affiliation: Universitaetsklinik fuer Innere Medizin II/Kardiologie, Medizinische Universitaet, Wien, Waehringer Guertel 18-20, 1090 Wien, Austria. georg.delle-karth@meduniwien.ac.at
authors.forename: Georg Delle
authors.initials: GD
authors.lastname: Karth
authors.forename: Anton
authors.initials: A
authors.lastname: Buberl
authors.forename: Mariam
authors.initials: M
authors.lastname: Nikfardjam
authors.forename: Brigitte
authors.initials: B
authors.lastname: Meyer
authors.forename: Gregor
authors.initials: G
authors.lastname: Wollenek
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Andrea
authors.initials: A
authors.lastname: Lassnigg
authors.forename: Werner
authors.initials: W
authors.lastname: Brannath
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000494:pharmacology*; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018932:Chemokine CCL2 / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000276:immunology*; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D018932:Chemokine CCL2; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D005340:Fibrinogen; D002097:C-Reactive Protein; D000638:Amiodarone