title: Pharmacologic cardioversion with intravenous amiodarone is likely safe in neurocritically Ill patients.
abstract: Neurological injury is often associated with cardiac abnormalities, including electrophysiological issues. Cardioversion of acute atrial fibrillation (<48h' duration) without anticoagulation carries about a 0.7% risk of thromboembolism. There is limited data on managing acute atrial fibrillation specifically in the neuroscience intensive care unit (NSICU) setting. We sought to determine the safety of using intravenous (IV) amiodarone for restoring sinus rhythm in patients with presumed new onset atrial or ventricular tachycardia after neurological injury. We conducted a retrospective review of consecutive patients admitted to our NSICU between June 2011 and March 2015 with a primary neurological diagnosis and new onset tachyarrhythmias who received IV amiodarone. Baseline demographics and presence of known risk factors for atrial fibrillation were recorded. The primary end point was new onset stroke. 48 patients were included for the final analysis. No patients developed new stroke after receiving IV amiodarone. The average follow up period was 14.0days. The majority of patients did not have the pre identified risk factors for atrial fibrillation. Ischemic stroke and traumatic brain injury were the most common admitting diagnoses. We conclude that in patients with primary neurological injury, use of IV amiodarone for rhythm control of acute onset atrial fibrillation carries a low risk of cardioembolic stroke in the first 2weeks. Further investigation, including prospective studies, with larger samples and longer follow up periods is warranted.
authors.affiliation: Departments of Neurology and Neurocritical Care, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Su
authors.affiliation: Department of Pharmacy, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room A903, Los Angeles, CA 90048, United States.
authors.forename: David
authors.initials: D
authors.lastname: Seki
authors.affiliation: Departments of Neurology and Neurocritical Care, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, United States. Electronic address: Asma.Moheet@cshs.org.
authors.forename: Asma M
authors.initials: AM
authors.lastname: Moheet
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016638:Critical Illness / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: Amiodarone; Arrhythmias, cardiac; Atrial fibrillation; Brain injuries, complications; Cardioversion; Sympathetic nervous system, pathology