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Efficacy of amiodarone for the termination of persistent atrial fibrillation
G E Kochiadakis1, N E Igoumenidis, M C Solomou
1Cardiology Department, University Hospital of Heraklion, Crete, Greece.
Insights
Amiodarone effectively converts persistent atrial fibrillation (AF) to sinus rhythm in nearly half of patients. This study found amiodarone safe and effective for AF termination, with smaller atria predicting successful conversion.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Persistent atrial fibrillation (AF) poses a significant clinical challenge.
- Effective and safe pharmacological interventions for AF conversion are needed.
Purpose of the Study:
- To evaluate the efficacy and safety of amiodarone for converting persistent atrial fibrillation (AF) to sinus rhythm.
- To identify predictors of successful cardioversion.
Main Methods:
- A prospective, randomized, controlled study involving 67 patients with persistent AF (>48 hours).
- Patients received either intravenous and oral amiodarone or placebo.
- Efficacy and safety outcomes were monitored.
Main Results:
- Amiodarone achieved conversion to sinus rhythm in 48.5% of patients, compared to 0% in the placebo group (p <0.001).
- No treatment-discontinuing side effects were observed.
- Smaller left atrial diameter was the only independent predictor of successful conversion.
Conclusions:
- Amiodarone is a safe and effective option for terminating persistent atrial fibrillation.
- Left atrial diameter is a key factor influencing the success of amiodarone therapy in AF patients.
Abstract:
The efficacy and safety of amiodarone in the conversion of persistent atrial fibrillation (AF) were investigated in a prospective, randomized, controlled study. Of 67 consecutive patients (32 men, mean age 64+/-9 years) with AF lasting >48 hours, 33 received amiodarone and 34 received placebo. Baseline clinical characteristics were similar in the 2 groups. Patients randomized to amiodarone received 300 mg intravenously for 1 hour and then 20 mg/kg for 24 hours. They were also given 600 mg/day orally, divided into 3 doses, for 1 week and thereafter 400 mg/day for 3 weeks. Patients randomized to placebo received an identical amount of saline IV over 24 hours and then oral placebo for 1 month. Conversion to sinus rhythm was achieved in 16 of the 33 patients (48.5%) who received amiodarone and in none of the 34 patients in the placebo group (p <0.001). None of the patients converted to sinus rhythm within the first 3 days. Those who converted had smaller atria than those who did not (diameter 41.9+/-7.2 vs 50.4+/-5.7 mm, p <0.001). Sex, age, baseline heart rate, left ventricular ejection fraction, and the duration of AF did not differ significantly between patients who converted and those who did not. No side effects requiring discontinuation of treatment were observed in either group. Amiodarone, administered both intravenously and orally, appears to be safe and effective in the termination of persistent AF. Left atrial diameter is the sole independent predictor of conversion.