Amiodarone as a first choice drug
- Niall Mulvahill1
© Biomed Central Ltd 2001
Received: 22 September 2000
Published: 17 October 2001
KeywordsChronic atrial fibrillayion, class III drugs, medical cardioversion
This paper describes a prospective randomised controlled study to assess the effectiveness of amiodarone in converting both short-term and long-lasting atrial fibrillation (AF) after 30 days of treatment.
This research was undertaken because of conflicting reports on the effectiveness (16%-19%) of amiodarone in the conversion of A F. This study also mandated that amiodarone was used as first line drug treatment.
Overall, 80.5% of the amiodarone group and 40% of the placebo group converted to sinus rhythm at 30 days
I found this article interesting because of the high success rate of conversion to sinus rhythm with amiodarone treatment in patients with increased left atrial size (46 mm; 61%) and those with chronic AF (35%). In accordance with other reports the longer duration of amiodarone treatment is associated with higher conversion rates in patients with chronic AF.
Possible implications of these findings are that prolonged use of amiodarone could be recommended in patients with dilated left atria and chronic AF after initial Failure of chemical cardioversion. For patients with recent onset AF with normal atrial size, the conversion rate to sinus rhythm with digoxin was >90%; suggesting that amiodarone is not necessary for the majority of this patient subgroup.
Patients received intravenous (24 h) followed by oral amiodarone or placebo. All patients received digoxin for the first 24 h. .