Cardiology, Department of Pharmacy Services, Allegheny General Hospital, Pittsburgh, PA, USA.
Ann Pharmacother. 2010 Sep;44(9):1496-500. doi: 10.1345/aph.1P075. Epub 2010 Jul 13.
To describe a challenging patient case in which dronedarone was selected for a patient with atrial fibrillation and heart failure; the drug may have been associated with worsening heart failure, leading to acute renal and hepatic failure.
A 47-year-old male with a history of heart failure with New York Heart Association class III-IV symptoms presented to our institution with ventricular fibrillation and ventricular tachycardia storm. Torsade de pointes secondary to a combination of dofetilide and hypokalemia was determined to be the etiology. Upon stabilization, the patient was initiated on dronedarone 400 mg orally twice daily by the electrophysiology service for atrial fibrillation. The patient had a questionable history of amiodarone intolerance. By hospital day 9 (day 4 of dronedarone therapy), the patient demonstrated a clinical picture consistent with acute renal and hepatic failure possibly due to worsening heart failure. Dronedarone was discontinued on hospital day 10. He was subsequently transferred to an outside hospital where he required milrinone therapy for cardiogenic shock. Laboratory markers of renal and hepatic function improved over the remainder of his hospitalization and he was discharged on hospital day 20.
Dronedarone is a newly approved antiarrhythmic agent with multichannel blocking properties similar to amiodarone. Use of the Naranjo probability scale determined that this patient's worsening heart failure leading to acute renal and hepatic failure was possibly caused by dronedarone. The implication from the ANDROMEDA trial as well as our experience in this case is that dronedarone should be used cautiously in patients with heart failure and avoided in patients specifically outlined in the product labeling.
This case report, to our knowledge, represents the first published postmarketing report of worsening heart failure complicated by multiorgan dysfunction in the setting of dronedarone initiation. Dronedarone use must be approached with caution in patients with a history of heart failure.
描述 1 例具有挑战性的患者病例，该患者患有心房颤动和心力衰竭，选择使用决奈达隆；该药物可能与心力衰竭恶化有关，导致急性肾和肝功能衰竭。
一名 47 岁男性，患有纽约心脏协会（NYHA）心功能分级 III-IV 级症状的心力衰竭病史，因室性纤颤和室性心动过速风暴就诊于我院。确定尖端扭转型室性心动过速继发于多非利特和低钾血症的联合作用。在稳定后，该患者在心电生理科开始服用 400mg 口服每日两次的决奈达隆，用于治疗心房颤动。该患者有可疑的胺碘酮不耐受病史。在入院第 9 天（使用决奈达隆第 4 天），该患者出现可能由心力衰竭恶化引起的急性肾和肝功能衰竭的临床表现。入院第 10 天停用决奈达隆。随后他被转至另一家医院，因心源性休克需要米力农治疗。住院期间，肝肾功能的实验室标志物逐渐改善，于入院第 20 天出院。
决奈达隆是一种新批准的抗心律失常药物，具有与胺碘酮相似的多通道阻断特性。使用 Naranjo 概率量表确定该患者的心力衰竭恶化导致急性肾和肝功能衰竭可能是由决奈达隆引起的。ANDROMEDA 试验以及我们在该病例中的经验表明，决奈达隆应谨慎用于心力衰竭患者，并且应避免在产品标签中明确列出的患者中使用。
据我们所知，该病例报告是首例在使用决奈达隆治疗后报道的心力衰竭恶化并伴有多器官功能障碍的上市后报告。在有心力衰竭病史的患者中，使用决奈达隆必须谨慎。
