Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study

Abstract

Intravenous dofetilide is significantly more effective than amiodarone or placebo in restoring sinus rhythm in patients with atrial fibrillation or flutter. However, when infused intravenously at this dose and rate, dofetilide causes a significant incidence of torsade de pointes.

Intravenous amiodarone bolus for treatment of atrial fibrillation in patients with advanced congestive heart failure or cardiogenic shock

“…Galve et al found no significant difference in the conversion rate between placebo and 5 mg/kg amiodarone given as a 30-minute infusion followed by 1,200 mg over 24 h [10]. Bianconi found no significant difference in conversion to sinus rhythm between placebo and 5 mg/kg amiodarone given as a 15-minutes infusion [29]. Martínez-Marcos compared amiodarone with flecainide and propafenone and observed a significantly lower conversion rate in patients treated with amiodarone given as a 5 mg/kg infusion in 20 minutes [30].…”

“…Martínez-Marcos observed symptomatic hypotension in 2 of 50 patients treated with amiodarone. In that study, symptomatic hypotension also occurred in 2 of 50 patients treated with flecainide, and 2 of 50 treated with propafenone, thus leaving the etiology of hypotension uncertain [29]. In a study comparing diltiazem with amiodarone, diltiazem had to be discontinued more often because of symptomatic hypotension [15].…”

Conversion of recent-onset atrial fibrillation or flutter with ibutilide after amiodarone has failed

“…Conversion rates of amiodarnone of 48-87% have been reported in critically ill patients [6,18]. The efficacy of amiodarone in atrial flutter is lower than that in atrial fibrillation [19]. However, 13-52% of patients remain in atrial fibrillation or flutter.…”

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

“…Multiple studies have noted the rate of chemical cardioversion (CCV) to increase in a dose-dependent manner, the SAFIRE-D trial noted rates of 29.9% for 500 mcg BID, 9.8% for 250 mcg BID and 6.1% for 125 mcg BID [88,93]. Dofetilide has been noted to be more effective for CCV in AFL than AF with reported comparisons of 65% vs. 25% [95], and 75% vs. 22% [96].…”