Continuous vs Episodic Prophylactic Treatment With Amiodarone for the Prevention of Atrial Fibrillation

Abstract

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.

Determinants and outcome of amiodarone-associated thyroid dysfunction

“…In our study population we observed a higher incidence of thyrotoxicosis compared to hypothyroidism. This is consistent with two previous studies conducted in the Netherlands 7,16 . The incidence reported in studies, however, varies greatly.…”

“…Dietary intake in the Netherlands is also relatively low and could account for the higher incidence of amiodaroneassociated thyrotoxicosis in the Netherlands. 7,16 In our study population, 42% of patients who encountered amiodarone-associated thyrotoxicosis reverted to normal thyroid function without any treatment or discontinuation of amiodarone. Most patients were considered to have type II amiodarone-associated thyrotoxicosis.…”

Predictors of the risk of falls among elderly with chronic atrial fibrillation

“…The frequency of adverse neurologic effects in longer-term amiodarone clinical trials has been much lower, at less than 5% (43,44,45,46), as in the present study.…”

Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months

“…The main implication of this study is that patients under amiodarone therapy for only 1 month after reversion of persistent AF show a higher incidence of arrhythmia recurrence, mortality, and cardiovascular hospitalizations. The main differences between the work of Ahmed et al [20] and our study is that they included patients who had had AF relapses, the short-term treatment with amiodarone lasted only for 1 month, and AF relapses were reverted during follow-up.…”