Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 71--72

Authors' reply

Hızır Okuyan1, Cihan Altın1, Okan Arıhan2,  
1 Department of Cardiology, Yenimahalle State Hospital, Ankara, Turkey
2 Department of Physiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Correspondence Address:
Hızır Okuyan
Yenibatı Mah, 2026 Cad, PK: 06370 Batıkent, Yenimahalle, Ankara

How to cite this article:
Okuyan H, Altın C, Arıhan O. Authors' reply.Ann Card Anaesth 2014;17:71-72

How to cite this URL:
Okuyan H, Altın C, Arıhan O. Authors' reply. Ann Card Anaesth [serial online] 2014 [cited 2021 Jun 16 ];17:71-72
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Full Text

Dear Editor,

I thank the author for the supportive comments and criticisms to our article "anaphylaxis during intravenous administration of amiodarone". [1] A trial fibrillation (AF) is the most common chronic cardiac arrhythmia occurring in 1-2% of the general population. [2],[3] AF is an independent risk factor for stroke; in fact, it increases the risk of stroke approximately fivefold. [4] In patients with AF, major mortality and morbidity are secondary to stroke and systemic embolism. The goals of management of acute AF are to relieve patients' symptoms and to prevent thromboembolic complication especially stroke. Clinical evaluation of AF should include determination of the estimation of stroke risk and search for conditions that predispose to AF and for complications of the arrhythmia. [2],[4] Many episodes of AF terminate spontaneously within the 1 st h or days. Medical cardioversion is indicated in patients with recent-onset AF who remain symptomatic despite adequate rate control. Pharmacological cardioversion may be initiated by a bolus administration of an antiarrhythmic drug. The conversion rate with antiarrhythmic drugs is lower than with direct current cardioversion, but does not require conscious sedation or anesthesia and may facilitate the choice of antiarrhythmic drug therapy to prevent recurrent AF. Several agents are available for pharmacological cardioversion. [4],[5] The Task Force the European Society of Cardiology [4] for the Management of AF recommends intravenous flecainide or propafenone for cardioversion of recent-onset AF when pharmacological cardioversion is preferred and there is no structural heart disease (Class I recommendation). In patients with recent-onset AF and structural heart disease, intravenous amiodarone is recommended (Class I recommendation). Digoxin, verapamil, sotalol, metoprolol, other beta-blocking agents and ajmaline are ineffective in converting recent onset AF to sinus rhythm and are not recommended (Class III recommendation). [4] Unfortunately, we did not have intravenous flecainide, propafenone or esmolol. Our patient was symptomatic even after rate control with administration of diltiazem. Therefore, we decided to administer amiodarone. Medical cardioversion was indicated in our patient, as she remained symptomatic even after adequate rate control. Therefore, amiodarone was administered for pharmacological cardioversion. It should be noted that The Task Force of the European Society of Cardiology has not considered metoprolol an effective drug for converting AF to sinus rhythm and not recommended. [4]


1Okuyan H, Altin C, Arihan O. Anaphylaxis during intravenous administration of amiodarone. Ann Card Anaesth 2013;16:229-30.
2Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, et al. Lifetime risk for development of atrial fibrillation: The Framingham Heart Study. Circulation 2004;110:1042-6.
3Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am 2008;92:17-40.
4European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, et al. Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-429.
5Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33:2719-47.