0425: Predictive factors of side effects of amiodarone in the amiotox registry

BackroundAmiodarone is a widely used antiarrhythmic drug in Tunisia and worldwide. However, its side effects are quite frequent hampering its use despite its efficacy.ObjectiveThe purpose of our study was to determin the prevalence of amiodarone side effects and to analyse its predictors in our population.ResultsFrom May 1st 2010 to April 30th 2012, 200 consecutive patients (mean age: 61.9±12.9 years) were included. Mean duration of amiodarone therapy was 51.9±48.4 months with a mean dose of 288.1±274.2g. Atrial fibrillation (81.5%) was the most common indication. Amiodarone side effects occurred in 144 patients (72%). Refering to multivariate analysis, independent predictors were:–Advanced age (p=0.02), treatment duration (p<0.001) and cumulative dose (p<0.001) for occurrence of all side effects.–Treatment duration > 6 months (p=0.008) for corneal deposits.–Age >70 years (p=0.001) and cumulative dose (p<0.00.1 with a logarithmic correlation) for thyroid toxicity.–Cumulative dose (p<0.001) and thyroid disease history (p=0.047) for hypothyroidism.–Age >70 years (p=0.002) and treatment duration (p<0.001 with a linear correlation) for cutaneous toxicity.–Cumulative dose >300g (p=0.012) and heart failure (p= 0.05) for bradycardia.–Cumulative dose >100g (p= 0.012) for QT prolongation–Treatment duration (p<0.001 with a linear correlation) and betablokers concomittent use (p=0.046) for PR elongation.–Treatment duration (p<0.001 with an exponential correlation) and concomittent VKA use (p=0.018) for hepatic toxicity.–Treatment duration > 18 months (p=0.009) and concomittent CCB use (p<0.001) for neurological toxicity.ConlusionThe results of our study confirmed that amiodarone side effects are quite frequent in our population, and that in addition to treatment dose and duration, other predictors for these effects were identified such as age and some drug associations

Hypertrophic obstructive cardiomyopathy with left ventricle outflow tract chordae insertion: Surgery or alcohol septal ablation? A case report

Key Clinical Message Anomalous insertion of chordae is a rare disease that could be associated with hypertrophic obstructive cardiomyopathy (HOCM), but clinical and echocardiographic diagnoses tend to be delayed. Alcohol septal ablation has emerged as an alternative to surgical myomectomy in HOCM. When a patient showed an anomalous insertion of chordae, physicians generally opt for surgery and not alcohol septal ablation. In this report, we present the case of a lady, with symptomatic HOCM associated with a chord inserted on the left ventricular outflow tract. We succeeded to relieve obstruction by alcohol septal ablation without the need for surgery