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When Sleep and Rhythm Collide: Amiodarone, Obstructive Sleep Apnoea, and Sinus Rhythm Maintenance After Cardioversion
Ke Wei Foong1, Amr Elkammash1,2, Daniel McKenzie1
1Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, BA1 3NG Bath, UK.
Reviews in Cardiovascular Medicine
|May 11, 2026
Summary
Amiodarone helps maintain sinus rhythm after atrial fibrillation cardioversion, especially in high-risk patients. Obstructive sleep apnea independently predicts cardioversion failure.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Atrial fibrillation (AF) and atrial flutter (AFL) recurrence post-cardioversion is common.
- Predictors of recurrence are known, but amiodarone's effectiveness is understudied.
- Current guidelines suggest amiodarone for high-risk patients, yet data is sparse.
Purpose of the Study:
- To evaluate amiodarone's effectiveness in maintaining sinus rhythm (SR) after direct current cardioversion (DCCV) for AF/AFL.
- To identify predictors of DCCV failure.
Main Methods:
- Retrospective analysis of 193 patients undergoing elective DCCV.
- Comparison of SR maintenance rates between amiodarone and non-amiodarone groups.
- Multivariate logistic regression to identify DCCV failure predictors.
Main Results:
- Amiodarone use was associated with significantly higher SR maintenance at 6 weeks (92.0% vs. 54.8%) and 12 months (60.0% vs. 26.8%).
- Obstructive sleep apnea (OSA) was the only independent predictor of DCCV failure (aOR 10.5).
- Amiodarone increased peri-procedural bradyarrhythmia risk (aOR 8.85).
Conclusions:
- Amiodarone improves SR maintenance post-DCCV for AF/AFL, even in high-risk patients.
- OSA is a significant predictor of DCCV failure.
- Further research is needed on amiodarone's role in OSA patients.
Keywords:
amiodaroneatrial fibrillationatrial flutterdirect current cardioversionobstructive sleep apnoeaMore Related Videos
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