Enhanced accessory pathway conduction following intravenous amiodarone in atrial fibrillation. A case report
Abstract
We observed a dangerous increase of ventricular rate following the intravenous administration of amiodarone in a patient with atrial fibrillation and rapid ventricular response associated with the Wolff-Parkinson-White syndrome. The mechanism of enhanced accessory pathway conduction remains speculative. A possible explanation for the shortened antegrade effective refractory period of the accessory pathway is afforded by the hypotensive action of amiodarone or its dissolvent which might trigger beta-adrenergic reflexes. Intravenous amiodarone should be used with caution in patients with atrial fibrillation and rapid ventricular response via an accessory pathway.
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In pre-excited atrial fibrillation, amiodarone may not be as safe as previously thought.
“In case of pre-excited AF, amiodarone may not be as a safe as previously thought.316 -319”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [317]
Cites
Digitalis in the pre-excitation syndrome. Analysis during atrial fibrillation.
Sellers, T. D., Bashore, T. M., & Gallagher, J. J. (1977) · Circulation · doi:10.1161/01.cir.56.2.260 · Cited by 232 · see citing works
Effect of amiodarone in the Wolff-Parkinson-White syndrome
Wellens, H. J. J., Lie, K. I., Bär, F. W. H. M., Wesdorp, J. C., Dohmen, H. J. M., Düren, D. R., & DURRER, D. (1976) · The American Journal of Cardiology · doi:10.1016/0002-9149(76)90148-x · Cited by 174 · see citing works
Wellens, H. J. J., Brugada, P., Abdollah, H., & Dassen, W. R. M. (1984) · Circulation · doi:10.1161/01.cir.69.1.120 · Cited by 138 · see citing works
Strasberg, B., Arditti, A., Sclarovsky, S., Lewin, R. F., Buimovici, B., & Agmon, J. (1985) · International Journal of Cardiology · doi:10.1016/0167-5273(85)90172-x · Cited by 65 · see citing works
Akhtar, M., Gilbert, C. J., & Shenasa, M. (1981) · Circulation · doi:10.1161/01.cir.63.2.435 · Cited by 47 · see citing works
Harper, R. W., Whitford, E. G., Middlebrook, K., Federman, J., Anderson, S. T., & Pitt, A. (1982) · The American Journal of Cardiology · doi:10.1016/0002-9149(82)90470-2 · Cited by 45 · see citing works
KAPPENBERGER, L. J., FROMER, M. A., Steinbrunn, W., & Shenasa, M. (1984) · The American Journal of Cardiology · doi:10.1016/0002-9149(84)90192-9 · Cited by 38 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Brugada, J., Katritsis, D. G., Arbelo, E., Arribas, F., Bax, J. J., Blomström‐Lundqvist, C., Calkins, H. G., Corrado, D., Deftereos, S. G., Diller, G., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz467 · Cited by 1,278 · see citing works
Andrade, J. G., Aguilar, M., Atzema, C. L., Bell, A., Cairns, J. A., Cheung, C. C., Cox, J. L., Dorian, P., Gladstone, D. J., Healey, J. S., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.09.001 · Cited by 568 · see citing works
Vassallo, P., & Trohman, R. G. (2007) · JAMA · doi:10.1001/jama.298.11.1312 · Cited by 442 · see citing works
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.856 · Cited by 439 · see citing works
2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.09.019 · Cited by 208 · see citing works
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000310 · Cited by 183 · see citing works
“Intravenous digoxin, intravenous amiodarone, intravenous or oral beta blockers, diltiazem, and verapamil are potentially harmful for acute treatment in patients with pre-excited AF (181-186).”
BackgroundGill, J., Heel, R. C., & Fitton, A. (1992) · Drugs · doi:10.2165/00003495-199243010-00007 · Cited by 156 · see citing works
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000311 · Cited by 595 · see citing works
“with success and complication rates similar to standard techniques (147, 149-152).”
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.09.019 · Cited by 100 · see citing works
Rosner, M. H., Brady, W. J., Kefer, M. P., & Martin, M. L. (1999) · The American Journal of Emergency Medicine · doi:10.1016/s0735-6757(99)90167-5 · Cited by 82 · see citing works
Pharmacologic Management of Supraventricular Tachycardias in Children
Luedtke, S. A., Kuhn, R. J., & McCaffrey, F. M. (1997) · Annals of Pharmacotherapy · doi:10.1177/106002809703101016 · Cited by 67 · see citing works
Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED
Fengler, B. T., Brady, W. J., & Plautz, C. U. (2007) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2006.10.017 · Cited by 64 · see citing works
Boriani, G., Biffi, M., Frabetti, L., Azzolini, U., Sabbatani, P., Bronzetti, G., Capucci, A., & Magnani, B. (1996) · American Heart Journal · doi:10.1016/s0002-8703(96)90098-8 · Cited by 62 · see citing works
MISUSE OF VERAPAMIL IN PRE-EXCITED ATRIAL FIBRILLATION
Garratt, C. J., Ward, D. E., Antoniou, A., & Camm, A. J. (1989) · The Lancet · doi:10.1016/s0140-6736(89)91734-0 · Cited by 56 · see citing works
Simonian, S. M., Lotfipour, S., Wall, C., & Langdorf, M. I. (2010) · Internal and Emergency Medicine · doi:10.1007/s11739-010-0385-6 · Cited by 47 · see citing works
“[13] Amiodarone 5 mg/kg in 10 min AF, 140 bpm ventricular rate with wide QRS complexes Within 10 min of amiodarone administration, the ventricular rate increased to 210 bpm and the systolic blood pressure dropped to 80 mmHg.”
BackgroundMethod2025 Clinical practice guidelines for Atrial fibrillation and flutter
Golukhova, E., Golitsyn, S., Mikhailov, E., Revishvili, A., Arakelyan, M., Vasilyeva, E., Davtyan, K., Drapkina, O., Drozdova, L., Kropacheva, E., et al. (2026) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2025-6668 · Cited by 36 · see citing works
Tijunelis, M. A., & Herbert, M. (2005) · Canadian Journal of Emergency Medicine · doi:10.1017/s148180350001441x · Cited by 36 · see citing works
“After 10 minutes, the rate slowed and sinus rhythm was restored.(16) In 1993 Pastor and colleagues published an abstract(18) titled “Ventricular fibrillation during treatment of atrial fibrillation with intravenous amiodarone in patients with the WPW syndrome.”
BackgroundPage, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.09.018 · Cited by 32 · see citing works
“Intravenous digoxin, intravenous amiodarone, intravenous or oral beta blockers, diltiazem, and verapamil are potentially harmful for acute treatment in patients with pre-excited AF (181-186).”
Background2020 Clinical practice guidelines for Supraventricular tachycardia in adults
Bokeria, L. A., Golukhova, E. Z., Popov, S. V., Artyukhina, Е. А., Базаев, В. А., Batalov, R. E., Bokeria, O. L., Vygovsky, A. B., Gilyarov, M. Y., Sp, G., et al. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4484 · Cited by 23 · see citing works
Ren, J., Yang, Y., Zhu, J., Wu, S., Wang, J., Zhang, H., & Shao, X. (2020) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14113 · Cited by 14 · see citing works
2025 Clinical practice guidelines for Supraventricular tachycardias
Popov, S. V., Davtyan, K. V., Shubik, Y. V., Artyukhina, Е. А., Базаев, В. А., Batalov, R. E., Bokeria, L. A., Bubnova, M. G., Vygovsky, A. B., Sp, G., et al. (2025) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2025-6448 · Cited by 12 · see citing works
Approach to a patient with asymptomatic pre-excitation
Antiperovitch, P., Skanes, A. C., Klein, G. J., & TANG, A. S. L. (2023) · Heart · doi:10.1136/heartjnl-2022-321639 · Cited by 8 · see citing works
Katritsis, D. G., Boriani, G., Cosío, F. G., Jaı̈s, P., Hindricks, G., Josephson, M. E., Keegan, R., Knight, B. P., Kück, K., Lane, D. A., et al. (2016) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2016:5.3.gl1 · Cited by 7 · see citing works
Lewis, R. V. (1990) · Drugs · doi:10.2165/00003495-199040060-00006 · Cited by 6 · see citing works
Mottram, A. R., & Svenson, J. E. (2011) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2011.08.007 · Cited by 5 · see citing works
The Management of Atrial Fibrillation
Rawles, J. M. (1992) · Springer eBooks · doi:10.1007/978-1-4471-1898-5_10 · Cited by 4 · see citing works
Tachydysrhythmia Treatment and Adverse Events in Patients with Wolff-Parkinson-White Syndrome
Siegelman, J. N., Marill, K. A., & Adler, J. N. (2014) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2013.11.127 · Cited by 4 · see citing works
Leiria, T. L. L., Mantovani, A., Ronsoni, R. D. M., Pires, L. M., Kruse, M. L., & de Lima, G. G. (2012) · Journal of Medical Cases · doi:10.4021//jmc.v3i5.700 · Cited by 3 · see citing works
“org which might trigger beta-adrenergic receptors, increasing the cardiac chronotropy and decreasing the anterograde refractory period of the accessory pathway [7].”
Leiria (2012) · Journal of Medical Cases · doi:10.4021/jmc700w · Cited by 3 · see citing works
Khatami, S., Khatami, H., Faghihi, M., Nikkhoo, M., Yousefifard, M., & Baratloo, A. (2025) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2025.10.038 · Cited by 1 · see citing works
Intravenous Amiodarone in Preexcited Atrial Fibrillation: A Systematic Review
Ali, Z. S., Nguyen, D. L., Bhuiyan, A., Ali, A., Hadi, A., Rivadeneira, J. E. L., Meghdadi, A., Abdollah, H., Gupta, S., McIntyre, W. F., et al. (2026) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.125.014529 · Cited by 1 · see citing works
Kardioversion von Vorhofflimmern und –flattern
Reisinger, J., & Siostrzonek, P. (2005) · Journal für Kardiologie (Krause & Pachernegg GmbH) · Cited by 1 · see citing works
Chen, W., Xiao, P., Zhou, G., Liu, Z., Chen, S., Du, H., Li, D., Zhang, C., Xu, Y., Li, S., et al. (2022) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14499 · Cited by 1 · see citing works
“The following data were collected and summarized from medical records of included patients: (1) demographic characteristics, (2) baseline medical history including the onset of main symptoms and the primary hospital therapeutic history, (3) comorbidities, (4) data on cardiac troponins, NT-proBNP levels, electrocardiog…”
BackgroundMethodAnti-arrhythmic Agents for Management of Supraventricular Tachycardia in Children
Luedtke, S. A., & McGinnis, B. (2004) · The Journal of Pediatric Pharmacology and Therapeutics · doi:10.5863/1551-6776-9.3.202
SAFETY OF AMIODARONE USAGE IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME AND ATRIAL FIBRILLATION
Kuzhel, D. A., Matyushin, G. V., & Александровна, С. Е. (2010) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2010-6-3-359-362
Brady, W. J., Chan, T. C., & Harrigan, R. (2003) · Emergency Medicine News · doi:10.1097/00132981-200306000-00016
- Authors
- Schützenberger, W., Leisch, F., & Gmeiner, R.
- Corresponding author
- Schützenberger, Wilhelm
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1987-07
- Volume
- 16
- Issue
- 1
- Pages
- 93-95
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2142945682
- Cited by
- 37
- References
- 7
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2016: 2 · 2015: 6 · 2014: 1 · 2012: 2
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- amiodarone, atrial fibrillation, accessory pathway conduction, Wolff-Parkinson-White syndrome, rapid ventricular response, hypotension, intravenous antiarrhythmic therapy
- MeSH terms
- Amiodarone, Atrial Fibrillation, Female, Heart Conduction System, Heart Rate, Humans, Middle Aged, Wolff-Parkinson-White Syndrome
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