Amiodarone versus Sotalol for Atrial Fibrillation

Singh, Bramah N.; Singh, Steven; Reda, Domenic J.; Tang, Xiaoyin; Lopez, Becky; Harris, Crystal L.; Fletcher, Ross D.; Sharma, Satish C.; Atwood, J. Edwin; Jacobson, A.; Lewis, H. Daniel; Raisch, Dennis W.; Ezekowitz, Michael D.

doi:10.1056/nejmoa041705

Cited by 670 publications

(373 citation statements)

References 39 publications

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“…47,50 In the Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T), patients with sustained sinus rhythm at 1 year (n = 304) had greater improvements in both exercise tolerance and quality of life relative to patients with persistent AF (n = 174). 45 Similar benefits were observed in a subsequent post-hoc analysis of quality of life and exercise performance. 46 Following on from early studies in catheter ablation in AF, a recent prospective study involving patients with CHF (n = 58) and without CHF (n = 58; ≥New York Heart Association [NYHA] Class II; left ventricular ejection fraction <45%) experienced improvements in symptoms, exercise capacity, and quality of life following the procedure (mean follow-up, 12 months).…”

Section: Mechanisms Of Af Development and Progressionsupporting

confidence: 59%

“…Similarly, in the SAFE-T study of amiodarone and sotalol in 665 patents with persistent AF, the 2 drugs were equally effective in converting AF to sinus rhythm, but amiodarone was superior for maintaining it (median time to recurrence of AF was 487 days and 74 days, respectively; P < 0.001). 45 However, the potential of amiodarone to cause serious adverse effects in the long term might preclude its use as a first-choice drug. In this regard, the potential for amiodarone to cause pulmonary toxicity may have been a factor in the significantly higher noncardiovascular death rate (including pulmonary deaths) reported for the rhythm-control arm of the AFFIRM study.…”

Section: Maintenance Of Sinus Rhythmmentioning

confidence: 99%

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Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Saliba

Wazni

2011

Clinical Cardiology

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Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia with substantial morbidity and mortality. This review briefly describes the mechanisms of AF development and progression, including electrical, structural, and contractile remodeling. In addition, the potential benefits of achieving and maintaining sinus rhythm are discussed. For example, rhythm control has been associated with improvements in left ventricular function, AF symptoms, exercise tolerance, the ability to perform activities of daily living, and quality of life. More recently, dronedarone, a noniodinated benzofuran derivative approved for use in the treatment of AF, was shown to significantly improve clinical outcomes including cardiovascular hospitalizations and death from any cause in A Placebo‐Controlled, Double‐Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter (ATHENA). The review concludes with an examination of AF treatment options and expectations. Evidence suggests that the complete absence of AF recurrence is not always achievable; however, complete restoration of sinus rhythm may not be necessary for patients to achieve clinically meaningful benefits. Copyright © 2011 Wiley Periodicals, Inc.The editorial assistance provided for this manuscript was funded by Sanofi‐Aventis. The authors were fully responsible for all content and editorial decision, and received no financial support or other form of compensation related to the development of the paper. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Mechanisms Of Af Development and Progressionsupporting

confidence: 59%

Section: Maintenance Of Sinus Rhythmmentioning

confidence: 99%

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Saliba

Wazni

2011

Clinical Cardiology

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“…Leki antyarytmiczne mogą przywracać rytm zatokowy u pacjentów z AF (kardiowersja farmakologiczna), co wykazano w małych kontrolowanych próbach klinicznych, metaanalizach [41,584,595,596] oraz niewielu większych kontrolowanych próbach klinicznych [597][598][599][600][601][602][603][604][605]. Poza Europą jest dostępny dofetilid, który może przerwać AF o niedawnym początku [606].…”

Section: Leki Antyarytmiczne W Celu Doraźnego Przywracania Rytmu Zatounclassified

“…Nie ma wiarygodnych danych, które wskazywałyby, że beta-adrenolityki [636], werapamil, diltiazem [637][638][639] oraz digoksyna [640,641] są skuteczne jako leki przerywające AF lub ułatwiające kardiowersję elektryczną. Jeżeli planuje się farmakoterapię antyarytmiczną w celu utrzymania rytmu zatokowego po kardiowersji, rozsądne wydaje się rozpoczę-cie tego leczenia 1-3 dni przed kardiowersją (w przypadku amiodaronu: kilka tygodni wcześniej) w celu ułatwienia kardiowersji i uzyskania skutecznego stężenia leku we krwi [584,601].…”

Section: Kardiowersja Elektrycznaunclassified

“…Stosowanie D sotalolu wiąże się ze zwiększe-niem umieralności w porównaniu z placebo u pacjentów z dysfunkcją lewej komory po zawale serca [665], prawdopodobnie z powodu komorowych zaburzeń rytmu (OR 2,47; 95% CI 1,2-5,05; liczba pacjentów, których trzeba leczyć w celu wystąpienia szkody u 1 pacjenta: 166, 95% CI 61-1159) [580,665]. Z drugiej strony d,l-sotalol stosowano u pacjentów z AF bez danych wskazujących na niekorzystny wpływ na bezpieczeństwo leczenia w 2 kontrolowanych próbach klinicznych [581,601].…”

Section: Sotalolunclassified

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,379

4,206

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Antiarrhythmic Drugs for Maintaining Sinus Rhythm After Cardioversion of Atrial Fibrillation

Mouly²,

et al. 2006

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Background: A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm. We performed a systematic review to determine the effect of long-term treatment with those drugs on death, embolisms, adverse effects, and atrial fibrillation recurrence.Methods: We searched MEDLINE, EMBASE, the Cochrane Library (all up to May 2005), and the reference lists of retrieved articles. We included randomized controlled trials that compared any antiarrhythmic against control (placebo or no treatment) or another antiarrhythmic, for more than 6 months. Postoperative atrial fibrillation was excluded. Two evaluators independently reviewed the retrieved studies and extracted all data. Disagreements were resolved by discussion. All results were calculated at 1 year of follow-up.Results: Forty-four trials were included, with a total of 11 322 patients. Several class IA (disopyramide phos-phate, quinidine sulfate), class IC (flecainide acetate, propafenone hydrochloride), and class III (amiodarone, dofetilide, sotalol hydrochloride) drugs significantly reduced recurrence of atrial fibrillation (number needed to treat, 2-9), but all increased withdrawals due to adverse effects (number needed to harm [NNH], 9-27) and all but amiodarone and propafenone increased proarrhythmia (NNH,. Class IA drugs, pooled, were associated with increased mortality compared with controls (Peto odds ratio, 2.39; 95% confidence interval, 1. P=.04; NNH, 109). No other antiarrhythmic showed a significant effect on mortality compared with controls. We could not analyze other outcomes because data were lacking. Conclusion:Class IA, IC, and III drugs are effective in maintaining sinus rhythm but increase adverse effects, and class IA drugs may increase mortality.

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Amiodarone versus Sotalol for Atrial Fibrillation

Cited by 670 publications

References 39 publications

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Antiarrhythmic Drugs for Maintaining Sinus Rhythm After Cardioversion of Atrial Fibrillation

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