Amiodarone to Prevent Recurrence of Atrial Fibrillation

Drug therapy for atrial fibrillation: quo vadis?

“…(33) EURIDIS and ADONIS were identical trials conducted in Europe and America showing the effi cacy of dronedarone at the maintenance of sinus rhythm after cardioversion with signifi cant success (hazard ratio = 0.75 and P<0.001) after 1 year follow-up. (34) The oneyear recurrence rate on dronedarone was 65%, whereas it was only 25% with amiodarone in the Canadian trial of Atrial Fibrillation, (35) suggesting that it is not quite as effi cacious as amiodarone. In ATHENA, the biggest anti-arrhythmic drug trial to date with 4 628 patients, dronedarone was shown to signifi cantly reduce the primary endpoint, In dog experiments, rotigaptide reduces vulnerability to AF in a mitral regurgitation model but not in a heart failure model, (39) and in atrial ischemia, but not in an atrial tachycardia model.…”

Rhythm Versus Safety in Amiodarone Therapy

“…In a prospective study of 403 patients with AF, Roy et al found amiodarone reduced the recurrence of AF to 35% versus 63% for sotalol, but adverse events contributed to discontinuation of drug therapy in 18% of patients receiving amiodaraone versus 11% of those treated with sotalol or propafenone. 6 …”

Pharmacological Treatment for Atrial Fibrillation

“…29) Similar comparison of the recurrence ratio of atrial fibrillation over an average of 16 months among amiodarone, sotalol or propafenone disclosed that the recurrent ratio of amiodarone accounted for 35%, with the counterparts of sotalol and propafenone being 63% (P < 0:001), indicating a higher maintenance effect of sinus rhythm with administration of amiodarone. 30) In the patients with chronic heart failure characteristic of presenting higher complication ratio with atrial fibrillation, the reduction ratio of heart rate during atrial fibrillation following administration of amiodarone accounted for 20% 2 weeks later and 14% even 12 months later, indicating a higher ratio relative to that with placebo (P ¼ 0:006) while the recovery ratio from atrial fibrillation to sinus rhythm was 31% and 8% (P ¼ 0:002), with the transition ratio from sinus rhythm to atrial fibrillation being 4.1% and 8.3%, respectively (P ¼ 0:005), suggesting the effectiveness of amiodarone. 21) These findings clearly indicate that the efficacy of K channel blockers is high in maintenance of sinus rhythm during lowered cardiac functions.…”

“…31) In Japan, K channel blockers are less frequently used for prevention of atrial fibrillation because the coverage of the National Health Insurance System price for amiodarone is limited to use in patients with atrial fibrillation accompanied by hypertrophic cardiomyopathy. However, based on clinical results in Europe and America, [12][13][14][15]21,29,30) application of K channel blockers is gradually increasing to include patients suffering from intractable atrial fibrillation. Considering this background, the enrolled patients were still …”