An atypically large 8000-mg oral amiodarone dose successfully cardioverted a 245-kg male with atrial flutter, with transient sinus arrest as the only adverse effect.
Case Report (n=1)
Does a high-dose oral amiodarone bolus successfully cardiovert atrial flutter in a high-risk obese patient with heart failure?
High-dose oral amiodarone boluses may be a reasonable strategy for cardioversion of atrial arrhythmias in patients with a large volume of adipose tissue.
In atrial arrhythmias, amiodarone is usually given either intravenously for acute management, requiring in-hospital monitoring, or orally for chronic control, as doses given 60 times per half-life, requiring weeks to reach full effect. A high-risk, 245-kg male with heart failure exacerbated by atrial flutter was successfully cardioverted using an atypically large, 8000-mg oral amiodarone dose. The only adverse effect was transient sinus arrest, which did not require intervention, only 24 hours of inpatient monitoring. Amiodarone's unique pharmacokinetics, including its long elimination half-life and its extensive distribution into a large volume of adipose tissue, make high-dose oral amiodarone boluses a reasonable strategy for cardioversion of atrial arrhythmias.
Le et al. (2022) conducted a case report in Atrial flutter exacerbating heart failure (n=1). High-dose oral amiodarone was evaluated on Cardioversion of atrial flutter. An atypically large 8000-mg oral amiodarone dose successfully cardioverted a 245-kg male with atrial flutter, with transient sinus arrest as the only adverse effect.