Alveolitis after treatment with amiodarone.

Abstract

later the patient was in slow junctional rhythm (35 beats/min), hypotensive, and poorly perfused.He responded promptly to ventricular pacing.At the time his other treatment included digoxin, frusemide, and isosorbide dinitrate.There was no electrolyte abnormality.No rise in enzyme activity occurred, and his serum digoxin concentration was 2 2 mg/l.Amiodarone was withdrawn and intermittent sinus node activity returned next day; within two days periods of normal sinus rhythm were noted.Spontaneous ventricular tachycardia requiring cardioversion recurred, however, so an atrioventricular sequential pacer was inserted and amiodarone reinstituted.As no other treat- ment was suitable for this patient he was discharged with this regimen. CommentSinus bradycardia and sinoatrial block have been described as side effects of amiodarone,' but to our knowledge sinus arrest has not been reported and no such case has been notified either to Sanofi Inc, the US agent for the manufacturers of the drug, or to the Food and Drug Administration.Both patients had normal sinus node automati- city as shown by corrected sinus node recovery times within the normal range, this being considered the best available test of sinus node auto- maticity and possibly of overall node function.4Amiodarone depressed automaticity by inhibiting phase 4 depolarisation in the sinus node of rabbits in vitro,5 and these observations suggest that such a mechanism may account for this potentially lethal complication in susceptible patients.