@Article{chd.12657,
AUTHOR = {Benjamin M. Moore, Rachael L. Cordina, Mark A. McGuire, David S. Celermajer},
TITLE = {Adverse effects of amiodarone therapy in adults with congenital heart disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {944--951},
URL = {http://www.techscience.com/schd/v13n6/39070},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Amiodarone is a highly effective antiarrhythmic therapy, however its tox‐
icity profile often limits treatment. This is particularly relevant in adults with congeni‐
tal heart disease (CHD), who are often young and in whom other antiarrhythmic 
agents commonly fail or are contraindicated. We sought to determine incidence and 
predictors of adverse effects caused by amiodarone in adult CHD (ACHD).<br/>
<b>Design:</b> A retrospective review of patients with moderate to complex ACHD treated 
with amiodarone at our center between 2000 and 2017 was performed. Incidence 
and predictors of adverse effects were described. Efficacy of amiodarone therapy in 
controlling the clinical arrhythmia was assessed as complete, partial, or failed.<br/>
<b>Results:</b> Amiodarone was prescribed in 57 patients of 902 ACHD patients reviewed 
(6%), for a mean duration of 2.7 ± 4.3 years. Significant adverse effects occurred in 
56%, most commonly thyroid dysfunction, with amiodarone‐induced thyrotoxicosis 
(AIT) in 30% and amiodarone‐induced hypothyroidism in 14%. AIT frequently led to 
arrhythmia exacerbation and occurred most in those with Fontan anatomy. Severe 
dermatological effects were seen in 7% and bradycardia requiring pacing in 5%. 
Interstitial lung disease, peripheral neuropathy and alopecia were observed in single 
cases. Amiodarone toxicity led to discontinuation of the drug in 42%. Amiodarone 
was highly effective when tolerated, however, achieving complete arrhythmia con‐
trol in 63%, partial control in 35%, with failure to control in only one patient.<br/>
<b>Conclusions:</b> Amiodarone therapy is effective in moderate to complex ACHD pa‐
tients, but is frequently limited by adverse effects. ACHD patients seem especially 
vulnerable to thyroid dysfunction, with Fontan patients in particular at increased 
risk of AIT.},
DOI = {10.1111/chd.12657}
}