During median follow-up of 3·3 years, the incidence of amiodarone-associated thyrotoxicosis was higher compared to hypothyroidism. Only general predictors for amiodarone-associated thyroid dysfunction were observed. Discontinuation of amiodarone did not influence treatment outcome.

It may cause symptoms, heart failure, and stroke. 1 Recent studies have established that morbidity and mortality are comparable between rate-and rhythm-control therapy. 2-5 However, long-term maintenance of sinus rhythm provides a variety of benefits, including an improvement in cardiac function and quality of life. 6-8 Therefore, maintenance of sinus rhythm is still the treatment of choice in symptomatic patients, those with tachycardiomyopathy, and when adequate rate control cannot be achieved. 3 However, success of pharmacological rhythm control is rather limited. 3,9 With a serial antiarrhythmic drug approach, no more than 40% of the patients are in sinus rhythm after a year and only about 30% after 4 years. 9 Of all class I, II, and III antiarrhythmic drugs, amiodarone is the most effective antiarrhythmic drug in preventing atrial fibrillation. 10-13 Amioda-rone maintains sinus rhythm in 45% to 70% of the patients during 12 to 54 months of follow-up. 11 Unfortunately, amiodarone causes many (noncardiac) adverse events, which are mostly Author Affiliations and a List of the CONVERT Investigators are listed at the end of this article.

Epicardial PVI using monolateral right-sided VATS with the UltraCinch delivering HIFU is feasible, but is associated with substantial complications. Furthermore, the success rate was low. More research is therefore warranted to assess optimal ablation techniques and energy sources to perform PVI.