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Is Cordarone Or Amiodarone Advisable After Cardiac Resynchronization Therapy?
Question: Is cordarone / or amiodarone advisable for patient with CRT-D to use it for long period aftet surgery????
Brief Answer:
Amiodarone is a medical option for arrhythmia.
Detailed Answer:
Hello! Thank you for asking on HCM!
Regarding your concern about Amiodarone use in patients with CRT-D the answer is YES! In a patient with heart failure and very low left ventricular ejection fraction there exists usually a predisposition for cardiac arrhythmia and not rarely even life - threatening ventricular arrhythmia (especially when hemodynamic status is severely unfavorable).
Cardiac Resynchronisation Therapy (CRT) aims at increasing LV ejection fraction, and thus a more favorable hemodynamic status. This will decrease the underlying cardiac pathology potential to produce eventual arrhythmia. So to cut it clear and short for you CRT is effective in reducing the arrhythmia burden. BUT there exists place even for medical therapy (Amiodarone), as arrhythmia occurs even in a synchronised heart. But adding amiodarone in this case would be under medical prescription judging specific situations.
I don't know exactly what surgery is going to have your mother, but regarding Amiodarone use it doesn't matter.
Only in cases of severe pulmonary fibrosis, liver and renal insufficiency amiodarone use would be considered dangerous, accounting its potential toxic effects.
If you send me more specific and detailed informations I could give a concrete opinion.
What is the primary underlying cardiac disorder? Is there a prior history of cardiac arrhythmia or sudden death? Etc.
Hope to have been helpful to you! Feel free to ask me whenever you need! Greetings from Dr. Iliri.
Amiodarone is a medical option for arrhythmia.
Detailed Answer:
Hello! Thank you for asking on HCM!
Regarding your concern about Amiodarone use in patients with CRT-D the answer is YES! In a patient with heart failure and very low left ventricular ejection fraction there exists usually a predisposition for cardiac arrhythmia and not rarely even life - threatening ventricular arrhythmia (especially when hemodynamic status is severely unfavorable).
Cardiac Resynchronisation Therapy (CRT) aims at increasing LV ejection fraction, and thus a more favorable hemodynamic status. This will decrease the underlying cardiac pathology potential to produce eventual arrhythmia. So to cut it clear and short for you CRT is effective in reducing the arrhythmia burden. BUT there exists place even for medical therapy (Amiodarone), as arrhythmia occurs even in a synchronised heart. But adding amiodarone in this case would be under medical prescription judging specific situations.
I don't know exactly what surgery is going to have your mother, but regarding Amiodarone use it doesn't matter.
Only in cases of severe pulmonary fibrosis, liver and renal insufficiency amiodarone use would be considered dangerous, accounting its potential toxic effects.
If you send me more specific and detailed informations I could give a concrete opinion.
What is the primary underlying cardiac disorder? Is there a prior history of cardiac arrhythmia or sudden death? Etc.
Hope to have been helpful to you! Feel free to ask me whenever you need! Greetings from Dr. Iliri.
Above answer was peer-reviewed by :
Dr. Raju A.T
The surgery from preview question is implanting the CRTD. As the local doctor preferred to discontinue cordarone/ aimodaron do of no nucessary and side effect. Is that true????e
Brief Answer:
CRT-D superior to amiodarone.
Detailed Answer:
Hello again! As we are talking about CRT-D implantation, then Amiodarone may not be necessary as it is expected an improved hemodynamic profile (CRT), and implanted defibrillator (D) protects from life - threatening ventricular arrhythmia. Nevertheless, if CRT doesn't result successful in reducing arrhythmia burden and many defibrillator discharges disturb the patient, and also shortens battery life - span; or other supraventricular arrhythmia appear, then Amiodarone could be an option. It depends on the attending cardiologist to decide the better strategy when dealing with recurrent arrhythmia.
Hope to have met your expectation about the answer. My best wishes! Dr. Iliri
CRT-D superior to amiodarone.
Detailed Answer:
Hello again! As we are talking about CRT-D implantation, then Amiodarone may not be necessary as it is expected an improved hemodynamic profile (CRT), and implanted defibrillator (D) protects from life - threatening ventricular arrhythmia. Nevertheless, if CRT doesn't result successful in reducing arrhythmia burden and many defibrillator discharges disturb the patient, and also shortens battery life - span; or other supraventricular arrhythmia appear, then Amiodarone could be an option. It depends on the attending cardiologist to decide the better strategy when dealing with recurrent arrhythmia.
Hope to have met your expectation about the answer. My best wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear doctor i enclosed report of my mother and yhe medication she takes after implantation of CRTD or B+ICD .
Brief Answer:
Carvedilol plus Ivabradine remain an attractive combination for the moment.
Detailed Answer:
Hello! As I mentioned above Amiodarone use is optional after CRT-D implantation. Facing your medical report results sinus rhythm and LBBB, low EF and moderate mitral regurgitation (from cardiac ultrasound exam prior to CRT-D procedure); I recommend a new cardiac ultrasound after procedure to evaluate the expected improvement in left ventricular systolic performance and thus to arrange the appropriate successive therapy. Based on the therapy and the clinical report you uploaded I don't find Amiodarone necessary for maintenance treatment.
For the moment Carvedilol plus Ivabradine seems a suitable and sufficient option. there is no need to complicate much more "the cocktail".
Remember that post procedure (CRT-D) cardiac ultrasound coupled with clinical improvements remain crucial for further medical opinions.
Feel free to ask me whenever you need!
My best wishes. Dr. Iliri.
Carvedilol plus Ivabradine remain an attractive combination for the moment.
Detailed Answer:
Hello! As I mentioned above Amiodarone use is optional after CRT-D implantation. Facing your medical report results sinus rhythm and LBBB, low EF and moderate mitral regurgitation (from cardiac ultrasound exam prior to CRT-D procedure); I recommend a new cardiac ultrasound after procedure to evaluate the expected improvement in left ventricular systolic performance and thus to arrange the appropriate successive therapy. Based on the therapy and the clinical report you uploaded I don't find Amiodarone necessary for maintenance treatment.
For the moment Carvedilol plus Ivabradine seems a suitable and sufficient option. there is no need to complicate much more "the cocktail".
Remember that post procedure (CRT-D) cardiac ultrasound coupled with clinical improvements remain crucial for further medical opinions.
Feel free to ask me whenever you need!
My best wishes. Dr. Iliri.
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thank you so much doctor for your excellent reply. Feel positive and relieve. But remain one what worry me the most. In accordance with medical report will recommended heart transplant since she is 57 years .
Brief Answer:
No need for heart transplant.
Detailed Answer:
Hello!
Regarding the idea of heart transplant it may be considered only if we are facing with a severe heart failure patient (NYHA class IV) not suitable for any available other options, and when maximal VO2<9-10 ml/kg/min (in cardio-respiratory stress test).
Facing the medical report and taking into account the CRT-D implantation (which is supposed to improve even more the cardiac performance) I do not think for cardiac transplant option actually.
It is necessary to make evidence of improvements after CRT-D procedure (need cardiac ultrasound and physical performance evaluation).
I wish you a good health for all the family! Greetings! Dr. Iliri
No need for heart transplant.
Detailed Answer:
Hello!
Regarding the idea of heart transplant it may be considered only if we are facing with a severe heart failure patient (NYHA class IV) not suitable for any available other options, and when maximal VO2<9-10 ml/kg/min (in cardio-respiratory stress test).
Facing the medical report and taking into account the CRT-D implantation (which is supposed to improve even more the cardiac performance) I do not think for cardiac transplant option actually.
It is necessary to make evidence of improvements after CRT-D procedure (need cardiac ultrasound and physical performance evaluation).
I wish you a good health for all the family! Greetings! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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