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Intravenous Amiodarone in Preexcited Atrial Fibrillation: A Systematic Review
Zain S Ali1, David L Nguyen2, Abdullah Bhuiyan1
1Faculty of Health Sciences, School of Medicine (Z.S.A., A. Bhuiyan, A.M.), Queen's University, Kingston, ON, Canada.
Circulation. Arrhythmia and Electrophysiology
|February 25, 2026
Summary
Intravenous amiodarone is rarely associated with ventricular fibrillation (VF) in preexcited atrial fibrillation (AF), despite current guidelines. This drug may be a viable alternative in resource-limited settings where other treatments are unavailable.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Current guidelines contraindicate intravenous amiodarone for preexcited atrial fibrillation (AF) due to ventricular fibrillation (VF) risk.
- Recommendations are based on limited case reports, contrasting with amiodarone's global use in resource-limited areas.
Purpose of the Study:
- To systematically review the safety of intravenous amiodarone in patients with preexcited AF.
- To assess the real-world availability of guideline-recommended alternative antiarrhythmic agents.
Main Methods:
- Systematic review of studies on intravenous amiodarone in preexcited AF and accessory pathway refractory periods.
- Pooled analysis of observational and interventional studies using a β-binomial model.
- Multinational survey of Latin American emergency departments regarding drug accessibility.
Main Results:
- Twelve studies (177 patients) were included; 4 case reports noted VF, but no VF occurred in 146 patients across observational/interventional cohorts.
- Estimated VF risk ranged from 0.12% to 0.68%.
- Amiodarone increased the anterograde effective refractory period; alternative agents were unavailable in surveyed centers.
Conclusions:
- Population-level evidence suggests a rare risk of VF with intravenous amiodarone in preexcited AF.
- Intravenous amiodarone may be a reasonable alternative for rhythm or rate control when guideline-recommended drugs are inaccessible.
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