Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). The Department of Veterans Affairs CHF-STAT Investigators. Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation: a randomized, controlled study. Efficacy of Amiodarone for the Termination of Chronic Atrial Fibrillation and Maintenance of Normal Sinus Rhythm: A Prospective, Multicenter, Randomized, Controlled, Double Blind Trial Long-term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses. Effects of Amiodarone and Diltiazem on Persistent Atrial Fibrillation Conversion and Recurrence Rates: A Randomized Controlled Study Ranolazine Added to Amiodarone Facilitates Earlier Conversion of Atrial Fibrillation Compared to Amiodarone‐Only Therapy Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. Amiodarone versus sotalol for atrial fibrillation. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Low-dose amiodarone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group. Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation. Exercise capacity in atrial fibrillation: a substudy of the Sotalol-Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T). An evaluation of the strategy of maintenance of sinus rhythm by antiarrhythmic drug therapy after ablation and pacing therapy in patients with paroxysmal atrial fibrillation. A randomized comparison of amiodarone and class IC antiarrhythmic drugs to treat atrial fibrillation in patients paced for sinus node disease: the Prevention Investigation and Treatment: A Group for Observation and Research on Atrial arrhythmias (PITAGORA) trial. Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone. A randomized, placebo-controlled study. A randomized placebo-controlled trial of pre-treatment and short- or long-term maintenance therapy with amiodarone supporting DC cardioversion for persistent atrial fibrillation.
BACKGROUND In a multicenter , double-blind , placebo-controlled study , the long-term effects of amiodarone on morbidity and mortality in patients with congestive heart failure ( CHF ) and atrial fibrillation ( AF ) were evaluated during a 4-year period . METHODS AND RESULTS Of 667 patients with CHF , 103 ( 15 % ) had AF at baseline . Of these , 51 were r and omized to amiodarone and 52 to placebo . The group with sinus rhythm and the group in AF were comparable except for a higher proportion of AF in patients with nonischemic versus ischemic cardiomyopathy ( 41 % versus 27 % , P<0.005 ) . The mean ventricular response ( VR ) during AF over 24 hours was reduced by amiodarone at 2 weeks ( 20 % , P=0.001 ) , at 6 months ( 18 % , P=0.001 ) , and at 12 months ( 16 % , P=0.006 ) . Maximal VR was reduced 22 % ( P=0.001 ) at 2 weeks , 19 % ( P=0.001 ) at 6 months , and 14 % ( P=0.001 ) at 12 months . Sixteen of 51 patients on amiodarone and 4 of 52 on placebo converted to sinus rhythm during the study ( chi2=9.23 , P=0.002 ) . During follow-up , 11 of 268 patients in sinus rhythm on amiodarone at baseline and 22 of the 263 in sinus rhythm on placebo developed AF ; the difference was significant ( chi2=12.88 , P=0.005 ) . Analysis of total mortality during follow-up showed a significantly lower mortality rate ( P=0 . 04 ) in patients in AF at baseline who subsequently converted to sinus rhythm on amiodarone than in those who did not convert to sinus rhythm on the drug . CONCLUSIONS In patients with CHF , amiodarone has a significant potential to spontaneously convert patients in AF to sinus rhythm , with patients who convert having a lower mortality rate than those who do not . The drug prevented the development of new-onset AF and significantly reduced the VR in those with persistent AF STUDY OBJECTIVES To investigate the efficacy and safety of amiodarone administered as the drug of first choice in the conversion of atrial fibrillation , regardless of its duration . DESIGN : Prospect i ve , r and omized , controlled clinical study . SETTING : Tertiary cardiac referral center . PATIENTS Two-hundred eight consecutive patients ( 102 men ; mean [ + /- SD ] age , 65 + /- 10 years ) with atrial fibrillation . INTERVENTIONS One-hundred eight patients received amiodarone , and 100 patients received placebo treatment . Patients r and omized to amiodarone received 300 mg IV for 1 h , and then 20 mg/kg for 24 h. They were also given 600 mg/d orally , divided into three doses , for 1 week , and thereafter 400 mg/d for 3 weeks . Patients r and omized to placebo treatment received an identical amount of saline solution IV over 24 h , and oral placebo treatment for 1 month . MEASUREMENTS AND RESULTS Baseline clinical characteristics were similar in the two groups . Conversion to sinus rhythm was achieved in 87 of 108 patients ( 80.05 % ) who received amiodarone , and in 40 of 100 patients ( 40 % ) in the placebo group ( p < 0.0001 ) . Statistical analysis showed that the duration of the arrhythmia and the size of the left atrium affected both the likelihood of conversion to sinus rhythm and the time to conversion in both groups . No side effects requiring discontinuation of treatment were observed in either group . CONCLUSIONS Amiodarone appears to be safe and effective in the termination of atrial fibrillation . However , extreme cases with a large left atrium and long-lasting arrhythmia need long-term therapy Objective : We sought to assess the efficacy and safety of amiodarone for restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation in a prospect i ve , r and omized , double blind trial . Background : Restoration and preservation of sinus rhythm is difficult in patients with chronic atrial fibrillation . The efficacy of oral amiodarone has not been conclusively established . Methods : Ninety-five patients with chronic atrial fibrillation , lasting an average of 35.6 months , were r and omized to either amiodarone ( 600 mg/d ) ( 47 patients ) or placebo ( 48 patients ) during four weeks . Nonresponders underwent electric cardioversion , and those who reverted continued with amiodarone ( 200 mg/d ) or placebo . End-points were successful cardioversion and sinus rhythm maintenance . Results : Sixteen patients ( 34.04 % ) in the amiodarone group reverted within 27.28 ± 8.85 days in comparison with 0 % in the placebo group ( P < 0.000009 ) . The conversion rate rose to 51.72 % in patients with chronic atrial fibrillation lasting less than 12 months . Twenty-eight patients in the amiodarone group and 39 in the placebo group underwent electric cardioversion , which was successful in 19 patients ( 67.8 % ) of the amiodarone group and in 15 ( 38.46 % ) of the placebo group ( P = 0.017 ) . Altogether , conversion was obtained in 79.54 % of the amiodarone group patients and in 38.46 % of the placebo group patients ( P < 0.0001 ) . During follow-up , atrial fibrillation relapsed in 13 ( 37.14 % ) of 35 patients of the amiodarone group within 8.84 + 8.57 months and in 12 ( 80 % ; P = 0.009 ) of 15 patients of the placebo group within 2.74 ± 3.41 months . Conclusions : Oral amiodarone  restored sinus rhythm in one third of patients with chronic atrial fibrillation , increased the success rate of electric cardioversion , decreased the number of relapses and delayed their occurrence STUDY OBJECTIVES To compare the efficacy and safety of amiodarone and propafenone when used for the prevention of  atrial fibrillation ( AF ) and maintenance of normal sinus rhythm in patients with refractory AF . DESIGN Prospect i ve , r and omized , single-blind trial . SETTING Tertiary cardiac referral center . PATIENTS One hundred forty-six consecutive patients ( 72 men ; mean age , 63 + /- 10 years [ + /- SD ] ) with recurrent symptomatic AF . INTERVENTIONS We studied 146 patients after restoration of sinus rhythm ; patients were r and omized to amiodarone , 200 mg/d , or propafenone , 450 mg/d . Follow-up clinical evaluations were conducted at the first , second , fourth , and sixth months , and at 3-month intervals thereafter . The proportion of patients relapsing to AF and /or experiencing side effects was calculated for each group using the Kaplan-Meier method . End point of the study was recurrence of AF or occurrence of side effects necessitating discontinuation of medication . MEASUREMENTS AND RESULTS Of 146 patients , 72 received amiodarone and 74 received propafenone . The two groups were clinical ly similar . Of the 72 patients receiving amiodarone , AF developed in 25 patients , after an average of 9.8 months , compared to 33 of the 74 patients receiving propafenone after an average of 3.8 months . Twelve patients receiving amiodarone and 2 patients receiving propafenone had side effects necessitating withdrawal of medication while still in sinus rhythm . CONCLUSIONS Amiodarone tends to be more effective than propafenone in maintaining sinus rhythm in patients with AF , but this advantage is offset by a higher incidence of side effects Abstract Purpose : To assess the effects of amiodarone and diltiazem on atrial fibrillation ( AF ) induced atrial electrical remodeling and their clinical implication s. Methods : Persistent AF patients were r and omly assigned to three treatment groups over a period from 6 weeks before to 6 weeks after internal cardioversion : group A ( 35 patients , oral diltiazem ) , group B ( 34 patients , oral amiodarone ) and group C ( 37 patients , no antiarrhythmic drugs ) . Several electrophysiological parameters were assessed 5 min and 24 h after cardioversion . Results : Compared with controls , group B patients had significantly higher conversion rates ( 83 % vs. 100 % , p = 0.041 ) and a higher probability to maintain sinus rhythm ( p = 0.037 ) . Patients of group B had longer fibrillatory cycle length intervals than patients of group A and C ( 180 ± 18 ms vs. 161 ± 17 ms vs. 164 ± 19 ms , p = 0.001 ) and longer atrial effective refractory periods ( 211 ± 22 ms vs. 198 ± 16 ms vs. 194 ± 17 ms , p = 0.003 ) as assessed 5 min after conversion . Post-conversion density of supraventricular ectopics was significantly lower in group B compared to groups A and C ( p = 0.001 ) . Conclusions : Oral amiodarone  increases conversion rates , prolongs fibrillatory cycle length and atrial effective refractory period and preserves sinus rhythm after cardioversion in persistent AF patients by suppressing the atrial ectopics that trigger AF Background : Amiodarone ( AMIO ) is for many years effectively used to control ventricular rate during atrial fibrillation ( AF ) and to convert it into sinus rhythm . However , due to its delayed onset of action , ranolazine ( RAN ) , a new antianginal agent with atrial‐selective electrophysiologic properties , has recently been attempted as add‐on therapy with AMIO to facilitate AF conversion . Methods : To establish the role of this combination therapy , we enrolled 173 consecutive patients ( 68 ± 10 years , 54 % male ) with recent‐onset ( < 48‐hour duration ) AF who were eligible for pharmacologic cardioversion . Patients were r and omized to intravenous AMIO ( loading dose 5 mg/kg in 1 hour followed by 50 mg/h ; n = 81 ) , or AMIO plus a single oral dose of RAN 1 g ( n = 92 ) . Results : Mean left atrial diameter did not significantly differ between groups , AMIO and AMIO + RAN ( 4.2 ± 0.5 cm vs 4.1 ± 0.4 cm , P = 0.18 ) . The AMIO + RAN group compared with the AMIO‐only group showed significantly shorter time to conversion ( 8.6 ± 2.8 hours vs 19.4 ± 4.4 hours , P < 0.0001 ) and higher conversion rate at 24 hours ( 98 % vs 58 % , P < 0.001 ) . Left ventricular ejection fraction did not markedly vary between the two groups and ranged within moderately reduced values . No serious clinical ly evident adverse effects were observed in any of the patients receiving either AMIO or the combination treatment . Conclusions : Our data demonstrate faster sinus rhythm restoration and enhanced conversion rate of AF  after AMIO plus RAN in patients with preserved ejection fraction and left atrial size , implicating a synergistic effect of the two agents OBJECTIVES This study evaluated the efficacy of antiarrhythmic drugs for the treatment of  atrial fibrillation ( AF ) .  BACKGROUND The most effective and safest antiarrhythmic drug for the treatment of AF is unknown . METHODS The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study compared two treatment strategies -- rate control and rhythm control -- in patients with AF and risk factors for stroke or death . This sub study , performed in patients r and omized to rhythm control , compared different antiarrhythmic drugs by r and omly assigning the first drug treatment to : 1 ) amiodarone , 2 ) sotalol , or 3 ) a class I drug . The primary end point was the proportion of patients alive , in sinus rhythm , with no additional cardioversions and still taking the assigned drug at one year . Comparisons were made between patients eligible for each of three drug pairs . RESULTS At one year , in 222 patients r and omized between amiodarone and class I agents , 62 % were successfully treated with amiodarone , compared with 23 % taking class I agents ( p < 0.001 ) . In 256 patients r and omized between amiodarone and sotalol , 60 % versus 38 % were successfully treated , respectively ( p = 0.002 ) . In 183 patients r and omized between sotalol and class I agents , 34 % versus 23 % were successfully treated , respectively ( p = 0.488 ) , although this portion of the sub study was stopped early when amiodarone was shown to be better than class I agents . Sinus rhythm was achieved in nearly 80 % of patients at one-year follow-up with serial therapy . Adverse effects were common . CONCLUSIONS Amiodarone was more effective at one year than either sotalol or class I agents for the strategy of maintenance of sinus rhythm without cardioversion BACKGROUND The optimal pharmacologic means to restore and maintain sinus rhythm in patients with atrial fibrillation remains controversial . METHODS In this double-blind , placebo-controlled trial , we r and omly assigned 665 patients who were receiving anticoagulants and had persistent atrial fibrillation to receive amiodarone ( 267 patients ) , sotalol ( 261 patients ) , or placebo ( 137 patients ) and monitored them for 1 to 4.5 years . The primary end point was the time to recurrence of atrial fibrillation beginning on day 28 , determined by means of weekly transtelephonic monitoring . RESULTS Spontaneous conversion occurred in 27.1 percent of the amiodarone group , 24.2 percent of the sotalol group , and 0.8 percent of the placebo group , and direct-current cardioversion failed in 27.7 percent , 26.5 percent , and 32.1 percent , respectively . The median times to a recurrence of atrial fibrillation were 487 days in the amiodarone group , 74 days in the sotalol group , and 6 days in the placebo group according to intention to treat and 809 , 209 , and 13 days , respectively , according to treatment received . Amiodarone was superior to sotalol ( P<0.001 ) and to placebo ( P<0.001 ) , and sotalol was superior to placebo ( P<0.001 ) . In patients with ischemic heart disease , the median time to a recurrence of atrial fibrillation was 569 days with amiodarone therapy and 428 days with sotalol therapy ( P=0.53 ) . Restoration and maintenance of sinus rhythm significantly improved the quality of life and exercise capacity . There were no significant differences in major adverse events among the three groups . CONCLUSIONS Amiodarone and sotalol are equally efficacious in converting atrial fibrillation to sinus rhythm .  Amiodarone is superior for maintaining sinus rhythm , but both drugs have similar efficacy in patients with ischemic heart disease . Sustained sinus rhythm is associated with an improved quality of life and improved exercise performance AIMS Direct current cardioversion of persistent atrial fibrillation is one of the most widely used and effective treatments for the restoration of sinus rhythm , but may be hampered by a low success rate and a high percentage of early recurrence . Pre-treatment with amiodarone or a glucose-insulin-potassium solution could improve the efficacy of electrical cardioversion by reversing the partially depolarized diastolic potential of the subsidiary pacemakers in atrial fibrillation . In a controlled r and omized study , we assessed the effectiveness of electrical cardioversion in patients with persistent atrial fibrillation after pre-treatment with amiodarone or potassium infusion and the efficacy of amiodarone in maintaining sinus rhythm after electrical cardioversion . METHODS AND RESULTS Ninety-two patients with persistent atrial fibrillation ( > 2 weeks duration ) were prospect ively r and omized into three matched groups : A ( n=31 , oral amiodarone 400 mg . day(-1)1 month before and 200 mg . day(-1)2 months after cardioversion ) , B ( n=31 , 180 mg . day(-1)oral diltiazem 1 month before and 2 months after cardioversion and 80 mmol potassium , 50 UI insulin in 500 ml 30 % glucose solution 24 h before cardioversion ) and C ( n=30 , control patients , 180 mg . day(-1)oral diltiazem 1 month before and 2 months after cardioversion ) . Before cardioversion all patients were under 4 weeks effective oral anticoagulant therapy ( warfarin ) . Before electrical cardioversion , the rate of spontaneous conversion to sinus rhythm was higher in group A ( 25 % ) than groups B ( 6 % ) or C ( 3 % ) ( P<0.005 ) . Electrical cardioversion was more successful in group A ( 88 % ) than groups B ( 56 % ) or C ( 65 % ) ( P<0.05 ) , while the electrical thresholds for effective cardioversion were lower in group B than the other groups ( P<0.05 ) . Twenty-four hours after cardioversion , the early recurrence of atrial fibrillation was similar in the three groups ( P = ns ) , while at 2 months the recurrence rate was lower in group A ( 32 % ) than groups B ( 56 % ) or C ( 52 % ) ( P<0.01 ) . CONCLUSION Pre-treatment with low-dose oral amiodarone , compared with oral diltiazem or glucose-insulin-potassium treatments , induces a significantly high percentage of instances of spontaneous conversion , increases electrical cardioversion efficacy and reduces atrial fibrillation recurrence To compare the safety and efficacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation ( AF ) , 70 patients were entered into a r and omized , double-blind study . Of these , 35 received amiodarone and 35 sotalol . There were no significant differences in baseline clinical characteristics between groups . Patients with ejection fraction < 40 % or clinical ly significant heart disease were excluded . Patients r and omized to amiodarone began with 800 to 1,600 mg/day for 7 to 14 days orally . After the initial loading phase , the drug dose was tapered to maintenance levels over 7 to 12 days ; thereafter , therapy was generally maintained at a dosage of 200 mg/day . The sotalol dosage was 80 to 360 mg twice daily , as tolerated . Follow-up clinical evaluations were conducted at 1 , 2 , 4 , 6 , 9 , and 12 months . The proportion of patients remaining in sinus rhythm on each agent was calculated for the 2 groups using the Kaplan-Meier method . Ten of the 35 patients who were taking amiodarone developed AF during the 12-month observation period , compared with 21 of the 35 who were taking sotalol ( p = 0.008 ) . No significant effect of sex , age , left atrial size , or type of AF could be detected that increased the risk of development of AF . We conclude that both amiodarone and sotalol can be used for the maintenance of normal sinus rhythm in patients with recurrent symptomatic AF but that amiodarone is the more effective of the 2 drugs for this purpose In patients with recent-onset atrial fibrillation ( AF ) , restoration of sinus rhythm is considered to be the first-line therapeutic option . Although this conversion might be obtained by direct-current shock or intravenous antiarrhythmic drugs , administration of an oral loading dose of class I or III antiarrhythmic drugs is more simple and convenient . This prospect i ve , r and omized , multicenter study compares the time to conversion to sinus rhythm obtained with an oral loading dose of propafenone or amiodarone .  Patients with recent-onset AF ( < 2 weeks ) , without contraindications for the 2 drugs , were r and omly assigned to be treated with propafenone ( 600 mg for the first 24 hours and if necessary a repeated dose of 300 mg for 24 hours ) or amiodarone ( 30 mg/kg for the first 24 hours and if necessary a repeated dose of 15 mg/kg for 24 hours ) . Exact conversion time during the first 24 hours was determined by Holter monitoring . In each treatment group 43 patients with the same baseline characteristics were included . The median time for restoration of sinus rhythm was shorter ( p = 0.05 ) in the propafenone ( 2.4 hours ) than in the amiodarone ( 6.9 hours ) group . After 24 hours ( 56 % in the propofenone and 47 % in the amiodarone group ) and 48 hours , the same proportion of patients in the 2 groups recovered sinus rhythm ( no serious adverse events were noticed ) . Thus , oral loading dose of propafenone or amiodarone was safe with a similar conversion rate of recent-onset AF .  Propafenone had a faster action The efficacy of amiodarone has been proved in long-term maintenance of sinus rhythm ( SR ) in patients with paroxysmal atrial fibrillation ( AF ) . The present study evaluates the efficacy and safety of a single oral dose of amiodarone in patients with recent-onset AF ( < 48 hours ) . Seventy-two patients were r and omized to receive 30 mg/kg of either amiodarone or placebo .  Conversion to SR was verified by 24-hour Holter monitoring . Ten patients were excluded because of SR in the beginning of monitoring or technical failure during Holter monitoring . The remaining study groups were comparable ( n = 31 for each ) , except that in the placebo group beta blockers were more common . The patients receiving amiodarone  converted to SR more effectively than those receiving placebo ( p<0.0001 ) . At 8 hours , approximately 50 % of patients in the amiodarone group and 20 % in the placebo group ( Holter successful ) had converted to SR , whereas after 24 hours the corresponding figures were 87 % and 35 % , respectively . The median time for conversion ( 8.7 hours for amiodarone and 7.9 hours for placebo ) did not differ in the groups . Amiodarone was hemodynamically well tolerated , and the number of adverse events in the study groups was similar . Amiodarone as a single oral dose of 30 mg/kg appears to be effective and safe in patients with recent-onset AF BACKGROUND Therapy for chronic atrial fibrillation ( AF ) focuses on rate versus rhythm control , but little is known about the effects of common therapeutic interventions on exercise tolerance in AF . METHODS Six hundred fifty-five patients with chronic AF underwent maximal exercise testing at baseline and 8 weeks , 6 months , and 1 year after r and omization to sotalol , amiodarone , or placebo therapy and attempted direct current cardioversion . Analyses of baseline determinants of exercise capacity , predictors of change in exercise capacity at 6 months and 1 year , and the short- and long-term effects of cardioversion on exercise capacity were made . RESULTS Age , obesity , and presence of symptoms accompanying AF were inversely associated with baseline exercise capacity , but these factors accounted for only 10 % of the variance in exercise capacity . Patients most likely to benefit from cardioversion were those most limited initially , younger , not obese or hypertensive , and with an uncontrolled ventricular rate at baseline . Conversion to sinus rhythm ( SR ) result ed in significant reductions in resting ( approximately 25 beat/min ) and peak exercise ( approximately 40 beat/min ) heart rates at 6 months and 1 year ( P < .001 ) . Successful cardioversion improved exercise capacity by 15 % at 8 weeks , and these improvements were maintained throughout the year . This improvement was observed both among those who maintained SR and those with intermittent AF . CONCLUSION Cardioversion result ed in a sustained improvement in exercise capacity over the course of 1 year , and this improvement was similar between those in SR and those with SR and recurrent AF . Patients most likely to improve with treatment tended to be younger and nonobese and have the greatest limitations initially AIMS Permanent atrial fibrillation develops in many patients after ablation and pacing therapy .  We compared a strategy that initially allowed patients to remain in atrial fibrillation with a strategy that initially attempted to restore and maintain sinus rhythm . METHODS AND RESULTS In this multicentre r and omized controlled trial , 68 patients affected by severely symptomatic paroxysmal atrial fibrillation were assigned , after successful atrioventricular junction ablation and pacing treatment  , to antiarrhythmic drug therapy with amiodarone , propafenone , flecainide or sotalol and were compared with 69 patients assigned , after successful AV junction ablation and pacing treatment , to no antiarrhythmic drug therapy . The patients were followed-up for 12 to 24 months ( mean 16+/-4 ) . The drug arm patients had a 57 % reduction in the risk of developing permanent atrial fibrillation ( 21 % vs 37 % , P=0.02 ) . Evaluation after 12 months revealed similar quality of life scores and echocardiographic parameters in the two groups , but the drug arm patients had more episodes of heart failure and hospitalizations ( P=0.05 ) . The outcome was similar between the 40 patients who developed permanent atrial fibrillation and the 97 who did not . CONCLUSION Conventional antiarrhythmic therapy reduces the risk of development of permanent atrial fibrillation after ablation and pacing therapy . The present data do not support the concept that the development of permanent atrial fibrillation is related to an adverse outcome when a perfect control of heart rate is obtained by ablation and pacing BACKGROUND Rhythm control is an important goal in the treatment of recurrent atrial tachyarrhythmias ( AT ) . The PITAGORA study was a r and omized trial in patients paced for sinus node disease ( SND ) , design ed to test the noninferiority of class IC antiarrhythmic drugs ( AADs ) to amiodarone in terms of a primary end point composed of death , permanent AT , cardiovascular hospitalization , atrial cardioversion , or AAD change . METHODS R and omization was stratified to assign 2 patients to  amiodarone  and 2 patients to class  IC AADs : propafenone or flecainide .  One hundred seventy-six patients ( 46 % men , 72 + /- 8 years ) were enrolled . Device diagnostics continuously monitored AT recurrences and duration . RESULTS In a mean follow-up of 20 + /- 9 months , the primary end point occurred in 23 ( 30.7 % ) of 75 class IC patients and in 28 ( 40.0 % ) of 70 amiodarone patients . The absolute difference in the end point incidence ( -9.3 % ; 95 % CI between 3.7 % and -22.3 % ) confirmed the noninferiority of class IC to amiodarone ( P = .007 ) . Kaplan-Meier 1-year freedom from AT episodes > 10 minutes , 1 day , and 7 days was 40 % , 73 % , and 91 % for amiodarone and 28 % , 78 % , and 86 % for class IC AADs ( P = nonsignificant ) . CONCLUSIONS In patients paced for SND and suffering from AT , class IC AADs proved not to be inferior to amiodarone in terms of the primary composite end point described or end points which were differently composed of mortality , efficacy , or AAD side effects . The AADs studied also showed similar results in terms of symptoms , quality of life , and freedom from AT recurrences BACKGROUND Spontaneous conversion of recent onset paroxysmal atrial fibrillation  to  normal sinus rhythm  occurs commonly and is not affected by low-dose amiodarone treatment . METHODS In a r and omized , placebo-controlled trial of 100 patients with paroxysmal atrial fibrillation of recent onset ( < 48 h ) we compared the effects of treatment with continuous intravenous amiodarone 125 mg per hour ( total 3 g ) and intravenous placebo .  Patients in the placebo group who did not convert to normal sinus rhythm within 24 h were started on amiodarone therapy . RESULTS Conversion to normal sinus rhythm occurred within 24 h in 32 of 50 patients ( 64 % ) in the placebo group , most of whom converted within 8 h. Lower conversion rates were observed in patients with hypertension , ischaemic heart disease or congestive heart failure and in patients with echocardiographic findings of left atrial diameter above 45 mm , ejection fraction below 45 % or significant mitral regurgitation . However , in most patients these clinical or echocardiographic risk factors of decreases in conversion rate were not present . In such patients the spontaneous conversion rate was approximately 90 % . The conversion rate during 24 h of treatment in the amiodarone group was 92 % ( P=0.0017 , compared to the placebo group ) . In this group , the conversion rate was largely unaffected by baseline characteristics . Of the 18 patients who did not convert with placebo , 15 ( 85 % ) converted after being crossed over to amiodarone . All patients not responding to high-dose amiodarone were in chronic atrial fibrillation within 1 month . In patients still in atrial fibrillation after 8 h of treatment , the pulse rate decreased significantly more in the amiodarone as compared to the placebo group ( 83+/-15 vs 114+/-20 beats . min(-1 ) , P=0.0014 ) . CONCLUSION The spontaneous conversion of recent onset paroxysmal atrial fibrillation is high and approaches 90 % in specific clinical and echocardiographically defined subgroups . Intravenous high-dose amiodarone safely facilitates conversion of paroxysmal atrial fibrillation . However , such treatment should be reserved for patients with unfavourable risk factor profiles , not converting during 8 h of observation or requiring rate control AIMS The efficacy of cardioversion ( DCCV ) for restoration of sinus rhythm ( SR ) in persistent atrial fibrillation ( AF ) is limited by a high relapse rate . Relapse may be reduced by amiodarone but no placebo-controlled trials of efficacy have been performed and the appropriate duration of therapy is unknown . METHODS AND RESULTS In this double-blind study , 161 subjects with persistent AF were r and omized to one of three groups-placebo ( n=38 ) ; amiodarone 400 mg BD for 2 weeks prior to DCCV and 200 mg daily for 8 weeks followed by placebo for 44 weeks ( n=62 , short-term amiodarone ) ; amiodarone 400 mg BD for 2 weeks then 200 mg daily for 52 weeks ( n=61 , long-term amiodarone ) . Spontaneous reversion to SR occurred before DCCV in 21 % ( 26/123 ) patients on amiodarone and none of the 38 patients on placebo ( absolute difference 21 % , 95 % confidence interval ( CI ) : 10 to 29 % , P=0.002 ) . At 8 weeks following DCCV , 51 % ( 63/123 ) patients on amiodarone remained in SR compared to 16 % ( 6/38 ) taking placebo ( difference-35 % 95 % CI : -48 to -18 % , P<0.001 ) . At 1 year , 49 % ( 30/61 ) patients on long-term amiodarone were in SR compared to 33 % ( 21/62 ) taking short-term amiodarone ( difference-15 % , 95 % CI : -31 to 2 % , P=0.085 ) . There was no difference in adverse event rate or quality of life scores between groups . CONCLUSIONS Amiodarone pre-treatment before electrical DCCV for persistent AF allows chemical conversion in one-fifth of patients without altering the efficacy of subsequent DC conversion . Amiodarone is more effective than placebo in the maintenance of SR when continued for 8 weeks following successful DCCV . More patients taking long-term amiodarone remained in SR at 52 weeks , but more had serious adverse effects requiring discontinuation of therapy . Eight weeks of adjuvant therapy with amiodarone following successful DCCV may be the preferred option
We found that the size of the left atrium , presence of cardiovascular disease , and protocol s of amiodarone administration did not influence the magnitude of effect .
Serious adverse events were infrequent .
Amiodarone is effective for converting AF to sinus rhythm in a wide range of patients .
BACKGROUND Although clinicians sometimes choose amiodarone to convert atrial fibrillation ( AF ) to sinus rhythm , no current and comprehensive systematic review has summarized its effectiveness .
OBJECTIVE To review the effectiveness of amiodarone in converting AF to sinus rhythm over a 4-week period .