Unforeseen consequences: Class III antiarrhythmic amiodarone stimulated increase in prostate-specific antigen

摘要

Patient care overview timeline. A: Initial diagnosis of atrial fibrillation (AF) in February 2010 and first direct current cardioversion (DCCV). B: First recurrence of AF and second DCCV with initiation (and discontinuation) of flecainide in June 2010. C: Second recurrence of AF and first radiofrequency ablation (RFA) pulmonary vein isolation in September 2014. D: Admission for third recurrence of AF with rapid ventricular response with third DCCV and redo RFA in March 2018. Patient was loaded with amiodarone (400 mg orally 3 times daily for 3 days while inpatient then discharged on 200 mg orally daily). E: Discontinuation of amiodarone in April 2018. F: Routine prostate-specific antigen (PSA) testing performed, resulting in total PSA 3.5 ng/mL, and patient reported as asymptomatic in September 2018. G: Fourth recurrence of AF and fourth DCCV. Amiodarone is reinitiated at 200 mg orally daily in October 2018. H: A routine ophthalmology visit for amiodarone toxicity surveillance noting concern for ocular involvement in August 2019. I: Routine lab work for amiodarone monitoring notes total PSA 5.4 ng/mL with percent free PSA 8.0% along with abnormal thyroid and liver function and leukopenia in mid-August 2019. J: Amiodarone discontinued following lab work results in mid-August 2019. K: Repeat lab work demonstrates return to near baseline total PSA 3.8 ng/mL and improved percent free PSA 11.6% 10 days after discontinuation of amiodarone. L: Surveillance lab work without change to PSA (total PSA 3.5 ng/mL and percent free PSA 12.3%) in January 2020.