Effect of Obesity on the Use of Antiarrhythmics in Adults With Atrial Fibrillation: A Narrative Review.

Shaikh, F; Wynne, R; Castelino, RL; Davidson, PM; Inglis, SC; Ferguson, C

Effect of Obesity on the Use of Antiarrhythmics in Adults With Atrial Fibrillation: A Narrative Review.

Shaikh, F Wynne, R Castelino, RL Davidson, PM Inglis, SC Ferguson, C

Permalink

Publisher:: WILEY
Publication Type:: Journal Article
Citation:: Clin Cardiol, 2024, 47, (8), pp. e24336
Issue Date:: 2024-08

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Published versionAdobe PDF (263.08 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Shaikh, F
dc.contributor.author	Wynne, R
dc.contributor.author	Castelino, RL
dc.contributor.author	Davidson, PM
dc.contributor.author	Inglis, SC
dc.contributor.author	Ferguson, C
dc.date.accessioned	2024-10-09T00:29:07Z
dc.date.available	2024-07-30
dc.date.available	2024-10-09T00:29:07Z
dc.date.issued	2024-08
dc.identifier.citation	Clin Cardiol, 2024, 47, (8), pp. e24336
dc.identifier.issn	0160-9289
dc.identifier.issn	1932-8737
dc.identifier.uri	http://hdl.handle.net/10453/181269
dc.description.abstract	BACKGROUND: Atrial fibrillation (AF) and obesity coexist in approximately 37.6 million and 650 million people globally, respectively. The anatomical and physiological changes in individuals with obesity may influence the pharmacokinetic properties of drugs. AIM: This review aimed to describe the evidence of the effect of obesity on the pharmacokinetics of antiarrhythmics in people with AF. METHODS: Three databases were searched from inception to June 2023. Original studies that addressed the use of antiarrhythmics in adults with AF and concomitant obesity were included. RESULTS: A total of 4549 de-duplicated articles were screened, and 114 articles underwent full-text review. Ten studies were included in this narrative synthesis: seven cohort studies, two pharmacokinetic studies, and a single case report. Samples ranged from 1 to 371 participants, predominately males (41%-85%), aged 59-75 years, with a body mass index (BMI) of 23-66 kg/m2. The two most frequently investigated antiarrhythmics were amiodarone and dofetilide. Other drugs investigated included diltiazem, flecainide, disopyramide, propafenone, dronedarone, sotalol, vernakalant, and ibutilide. Findings indicate that obesity may affect the pharmacokinetics of amiodarone and sodium channel blockers (e.g., flecainide, disopyramide, and propafenone). Factors such as drug lipophilicity may also influence the pharmacokinetics of the drug and the need for dose modification. DISCUSSION: Antiarrhythmics are not uniformly affected by obesity. This observation is based on heterogeneous studies of participants with an average BMI and poorly controlled confounding factors such as multimorbidity, concomitant medications, varying routes of administration, and assessment of obesity. Controlled trials with stratification at the time of recruitment for obesity are necessary to determine the significance of these findings.
dc.format	Print
dc.language	eng
dc.publisher	WILEY
dc.relation.ispartof	Clin Cardiol
dc.relation.isbasedon	10.1002/clc.24336
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology
dc.subject.classification	Cardiovascular System & Hematology
dc.subject.classification	3201 Cardiovascular medicine and haematology
dc.subject.mesh	Humans
dc.subject.mesh	Atrial Fibrillation
dc.subject.mesh	Obesity
dc.subject.mesh	Anti-Arrhythmia Agents
dc.subject.mesh	Middle Aged
dc.subject.mesh	Humans
dc.subject.mesh	Atrial Fibrillation
dc.subject.mesh	Obesity
dc.subject.mesh	Anti-Arrhythmia Agents
dc.subject.mesh	Middle Aged
dc.subject.mesh	Humans
dc.subject.mesh	Atrial Fibrillation
dc.subject.mesh	Obesity
dc.subject.mesh	Anti-Arrhythmia Agents
dc.subject.mesh	Middle Aged
dc.title	Effect of Obesity on the Use of Antiarrhythmics in Adults With Atrial Fibrillation: A Narrative Review.
dc.type	Journal Article
utslib.citation.volume	47
utslib.location.activity	United States
utslib.for	1102 Cardiorespiratory Medicine and Haematology
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)
pubs.organisational-group	University of Technology Sydney/UTS Groups/Digital, Virtual and AI in Health Collaborative (DVAIHC)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2024-10-09T00:29:05Z
pubs.issue	8
pubs.publication-status	Published
pubs.volume	47
utslib.citation.issue	8

Abstract:

BACKGROUND: Atrial fibrillation (AF) and obesity coexist in approximately 37.6 million and 650 million people globally, respectively. The anatomical and physiological changes in individuals with obesity may influence the pharmacokinetic properties of drugs. AIM: This review aimed to describe the evidence of the effect of obesity on the pharmacokinetics of antiarrhythmics in people with AF. METHODS: Three databases were searched from inception to June 2023. Original studies that addressed the use of antiarrhythmics in adults with AF and concomitant obesity were included. RESULTS: A total of 4549 de-duplicated articles were screened, and 114 articles underwent full-text review. Ten studies were included in this narrative synthesis: seven cohort studies, two pharmacokinetic studies, and a single case report. Samples ranged from 1 to 371 participants, predominately males (41%-85%), aged 59-75 years, with a body mass index (BMI) of 23-66 kg/m2. The two most frequently investigated antiarrhythmics were amiodarone and dofetilide. Other drugs investigated included diltiazem, flecainide, disopyramide, propafenone, dronedarone, sotalol, vernakalant, and ibutilide. Findings indicate that obesity may affect the pharmacokinetics of amiodarone and sodium channel blockers (e.g., flecainide, disopyramide, and propafenone). Factors such as drug lipophilicity may also influence the pharmacokinetics of the drug and the need for dose modification. DISCUSSION: Antiarrhythmics are not uniformly affected by obesity. This observation is based on heterogeneous studies of participants with an average BMI and poorly controlled confounding factors such as multimorbidity, concomitant medications, varying routes of administration, and assessment of obesity. Controlled trials with stratification at the time of recruitment for obesity are necessary to determine the significance of these findings.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/181269