Amiodarone in restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation after unsuccessful direct‐current cardioversion

Abstract

SummaryBackground: When direct-current (DC) cardioversion is used, sinus rhythm can be restored, at least temporarily, in 80-90% of patients with atrial fibrillation. However, there is a small but significant group of patients with chronic atrial fibrillation in whom DC cardioversion has failed to restore sinus rhythm. The value ofantiarrhythmic drug pretreatment before DC cardioversion is still controversial.Hypothesis: The aim of our study was to assess (1) the effecti veness of repeat DC cardioversion in patients with chronic atrial fibrillation after pretreatment with amiodarone, and ( 2 ) the efficacy of amiodarone in maintaining sinus rhythm after repeat cardioversion.Methods: Forty-nine patients with chronic atrial fibrillation after ineffective DC cardioversion were included in the study. Repeat DC cardioversion was performed after loading with oral amiodarone, 10-15 mgkg body weighdday for a period necessary to achieve the cumulative dose of over 6.0 g.Results: Spontaneous conversion to sinus rhythm during amiodarone pretreatment was achieved in 9 of 49 patients ( 18%). Direct-current cardioversion was performed in 39 patients and sinus rhythm was achieved in 23 of these patients (59%). Mean heart rate decreased from 95 beatdmin before to 68 beatdmin after DC cardioversion (p < 0.001). Systolic blood pressure significantly (p < 0.05) decreased from 126 &

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

“…Serious toxicity has been reported, including death due to bradycardia ending in cardiac arrest. 496,504,516,[527][528][529][530][531][532][533][534]537,551 8.1.5.4.2. DOFETILIDE.…”

“…Amiodarone can also usually be given safely on an outpatient basis, even in patients with persistent AF, because it causes minimal depression of myocardial function and has low proarrhythmic potential, 566 but in-hospital loading may be necessary for earlier restoration of sinus rhythm in patients with HF or other forms of hemodynamic compromise related to AF. Loading regimens typically call for administration of 600 mg daily for 4 wk 566 or 1 g daily for 1 wk, 531 followed by lower maintenance doses. Amiodarone, class IA or IC agents, or sotalol can be associated with bradycardia requiring permanent pacemaker implantation 639 ; this is more frequent with amiodarone, and amiodarone-associated bradycardia is more common in women than in men.…”

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

“…Amiodarone can also usually be given safely on an outpatient basis, even in patients with persistent AF, because it causes minimal depression of myocardial function and has low proarrhythmic potential, 258 but in-hospital loading may be necessary for earlier restoration of sinus rhythm in patients with HF or other forms of hemodynamic compromise related to AF. Loading regimens typically call for administration of 600 mg daily for 4 wk 258 or 1 g daily for 1 wk, 232 followed by lower maintenance doses. Amiodarone, class IA or IC agents, or sotalol can be associated with bradycardia requiring permanent pacemaker implantation 259 ; this is more frequent with amiodarone, and amiodarone-associated bradycardia is more common in women than in men.…”

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

“…Synchronised cardioversion with anterior-posterior electrode positioning and high initial biphasic energy of 200 joules is recommended. 72,74 Prior to this, electrolytes are supplemented to obtain high plasma levels (magnesium >1.0 mmol/l; potassium 4.5-5.5 mmol/l). 72,75,76 Improve Contractility…”