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. Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group. Intravenous Amiodarone Decreases the Duration of Atrial Fibrillation Associated with Acute Myocardial Infarction A Randomized Comparison of External and Internal Cardioversion of Chronic Atrial Fibrillation Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs. Long-term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses. Intravenous amiodarone in treatment of recent-onset atrial fibrillation: results of a randomized, controlled study. Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation. 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. Intravenous flecainide versus verapamil for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. Amiodarone versus sotalol for atrial fibrillation. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. Ibutilide versus amiodarone in atrial fibrillation: A double-blinded, randomized study Ranolazine Added to Amiodarone Facilitates Earlier Conversion of Atrial Fibrillation Compared to Amiodarone‐Only Therapy Pilsicainide for conversion and maintenance of sinus rhythm in chronic atrial fibrillation: a placebo-controlled, multicenter study. Control of rate versus rhythm in rheumatic atrial fibrillation: a randomized study. A comparative study of the efficacy and safety of procainamide versus propafenone versus amiodarone for the conversion of recent-onset atrial fibrillation. Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study. Conversion of recent-onset atrial fibrillation to sinus rhythm: effects of different drug protocols. Low-dose amiodarone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial.
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 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 Abstract Purpose : Atrial fibrillation ( AF ) is a fairly common complication of acute myocardial infa rct ion ( AMI ) . The aim of this study was to examine the safety and efficacy of intravenous amiodarone in converting AF associated with AMI . Methods : Seventy patients with AMI complicated with AF were prospect ively divided into 3 groups : a ) In group D ( n = 26 ) , 0.75 mg digoxin was administered intravenously and thereafter as needed , b ) In group AM ( n = 16 ) , 300 mg of amiodarone was infused over 2 hours followed by 44 mg/hour for up to 60 hours or until sinus rhythm was restored , c ) In group D + AM ( n = 28 ) , 0.75 mg of digoxin was administered ( as in group D ) for the initial 2 hours followed by amiodarone infusion as in group AM . Results : Sinus rhythm was restored : a ) by the end of the 2nd hour in 9/26 patients from group D , 4/16 from group AM , and 10/28 from group D + AM ( p = NS ) , b ) by the end of the 96th hour , in 18/26 patients from group D , and in all patients from group AM and groupd D + AM . The corresponding duration of AF was 51 ± 34 hours , 17 ± 15 hours and 9 ± 13 hours , respectively ( F = 15.4 , p < 0.001 ) . AF recurred in 9/26 , 5/16 and 1/28 patients of groups D , AM and D + AM , respectively ( p = 0.026 ) . The required dosage of amiodarone  was lower in the D + AM group than in the AM group ( 603 ± 563 mg versus 1058 ± 680 mg , p = 0.037 ) . Conclusions : Intravenous amiodarone was well tolerated in patients with AMI complicated by AF and was effective in decreasing the duration of AF . However , the combination of amiodarone and digoxin was superior to amiodarone alone in restoring sinus rhythm faster , maintaining sinus rhythm longer , and allowing the use of a lower cumulative amount of amiodarone Background Delivery of shocks within the right atrium has been reported to be more effective than conventional external shocks in converting atrial fibrillation ( AF ) , but these two cardioversion techniques have never been compared prospect ively . The purpose of this study was to compare the efficacies of external and internal cardioversion in patients with chronic AF unresponsive to prior attempts at electrical and /or pharmacological cardioversion . Low-dose amiodarone was used in all patients after cardioversion to suppress recurrences of AF . Methods and Results One hundred twelve patients with AF of at least 1 month in duration were r and omly assigned to undergo external cardioversion with 300–360-J shocks or internal cardioversion with 200–300-J shocks delivered through a st and ard electrode catheter within the right atrium . The patients were treated with amiodarone ( 200 mg/day 5–7 days/week ) for 1 month before electrical cardioversion and afterward if the cardioversion was successful . The patients were-evaluated at regular intervals during 1 year of follow-up . The efficacy of internal cardioversion was significantly greater than that of external cardioversion ( 91 % versus 67 % , p = 0.002 ) . The only variable that was associated with the outcome of cardioversion was body weight . Among patients in whom sinus rhythm was restored , AF recurred as often after internal and external cardioversion ; at 1 year of follow-up , 37 % of patients in whom external or internal cardioversion had been effective were still in sinus rhythm .  Patients who had undergone an attempt at electrical cardioversion before entry into this study were less likely to remain in sinus rhythm after cardioversion . The only complications of cardioversion were one instance of cerebral thromboembolism after external cardioversion and one instance of transient pulmonary edema after internal cardioversion . Therapy with amiodarone was discontinued because of an adverse drug effect in only three patients . Conclusions Internal cardioversion is more effective than external cardioversion in restoring sinus rhythm and is as safe as external cardioversion in patients with chronic AF . The recurrence rate of AF is the same after both types of cardioversion . If conventional electrical cardioversion is ineffective , internal cardioversion should be attempted . The combination of low-dose amiodarone and external or internal cardioversion may result in maintaining sinus rhythm long-term in patients with refractory AF AIM The aim of our study was to compare the efficacy and safety of ibutilide and amiodarone ( intravenously ) in converting  recent-onset atrial fibrillation ( AF ) and atrial flutter ( Af )  to sinus rhythm ( SR ) . METHODS The study was prospect i ve , r and omized and included 152 ( 103 men and 49 women ) consecutive patients with AF or Af of 3 - 48 h duration .  Ibutilide is a selective class III antiarrhythmic agent which when administered intravenously can terminate AF and Af .  Amiodarone is also a class III antiarrhythmic agent that when given intravenously or orally has proved to be more effective than other agents in terminating AF and Af [ B.N. Singh , F.V. Mody , B. Lopez , J.S. Sarma . Antiarrhythmic agents for atrial fibrillation : focus on prolonging atrial repolarization . Am J Cardiol 1999 Nov 4 ; 84 : 161R-173R . ] . Seventy-nine patients ( 56 with AF and 23 with Af ) that consisted group A were treated with ibutilide .  Seventy-three ( 52 with AF and 21 with Af ) consisted group B and were treated with intravenous infusion of amiodarone . RESULTS The conversion rate of group A ( ibutilide ) was significantly higher than the conversion rate of group B ( amiodarone ) ( 80 % vs. 57 % , p=0.0054 ) . As regards the kind of arrhythmia separately , for AF there was n't significant difference ( 77 % vs. 69 % , p = ns ) whereas for Af ibutilide was superior to amiodarone ( 87 % vs. 29 % , p=0.003 ) . The conversion rates of ibutilide did n't differ for AF and Af ( 77 % vs. 87 % , p = ns ) . CONCLUSIONS Ibutilide is more effective than amiodarone in converting recent-onset Af to SR whereas both drugs are equally effective in converting recent-onset AF to SR OBJECTIVE In this study , we r and omly compared single oral doses of flecainide , amiodarone and propafenone versus placebo for the conversion of  recent atrial fibrillation ( AF ) ( within 48 hours ) . METHODS This is a r and omized prospect i ve , placebo-controlled single-blind study that included 160 consecutive patients with recent AF who were r and omly assigned to single oral doses of flecainide ( 3 mg/kg of weight , n=40 ) , amiodarone ( 30 mg/kg weight , n=40 ) , propafenone ( 8.5 mg/kg of weight , n=40 ) or placebo ( n=40 ) . The primary end-point was conversion rate at 24 hours after the drug intake . The association between antiarrhythmic use and conversion rate was tested with multiple logistic regressions . RESULTS The primary end-point was achieved in 87.5 % of patients with flecainide , 85 % of patients with amiodarone , 85 % of patients with propafenone and 17.5 % of patients with placebo ( p<0.001 compared with placebo for all 3 drugs ) . Conversion rate within 3 hours after drug intake was greater with propafenone ( 57.5 % ) or flecainide ( 45 % ) compared with amiodarone ( 0 % ) or placebo ( 10 % ) . Between 6 and 24 hours , significantly more patients were converted to sinus rhythm with amiodarone than with flecainide or propafenone . The use of antiarrhythmic drugs was a significant predictor of conversion to sinus rhythm compared to placebo ( adjusted OR=19.53 , 95 % CI 3.14 - 121.55 , p<0.001 ) . No serious side effect occurred . CONCLUSION In patients with recent-onset AF , oral flecainide , amiodarone or propafenone are superior to placebo in restoring sinus rhythm within the 24-hour period following the drug intake 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 OBJECTIVES This study was design ed to determine the efficacy of intravenous amiodarone in the management of  recent-onset atrial fibrillation .  BACKGROUND The optimal approach for acute atrial fibrillation has not been established . Amiodarone is a unique antiarrhythmic agent with activity in both supraventricular and ventricular tachyarrhythmias , but its value for the restoration of sinus rhythm in patients with recent-onset atrial fibrillation has not been demonstrated . METHODS Sample size was calculated to detect a 25 % increase in reversion rate with amiodarone with a statistical power of 80 % . One hundred consecutive patients with recent-onset ( < 1 week ) atrial fibrillation and not taking antiarrhythmic agents were r and omized to receive either intravenous amiodarone , 5 mg/kg body weight in 30 min followed by 1,200 mg over 24 h , or an identical amount of saline . Both groups received intravenous digoxin , 0.5 mg initially , followed by 0.25 mg at 2 h and 0.25 mg every 6 h thereafter , to complete 24 h while the ventricular rate was > 100 beats/min . Amiodarone and digoxin  blood levels were determined . Both groups were homogeneous regarding underlying heart disease , time from onset to treatment , initial ventricular rate and left atrial size . RESULTS By the end of the 24-h treatment period , 34 patients ( 68 % , 95 % confidence interval [ CI ] 53 % to 80 % ) in the amiodarone group and 30 ( 60 % , 95 % CI 45 % to 74 % ) in the control group had returned to sinus rhythm ( p = 0.532 ) . Mean times ( + /-SD ) of conversion were 328 + /- 335 and 332 + /- 359 min , respectively ( p = 0.957 ) . Among patients who did not convert to sinus rhythm , treatment with amiodarone was associated with a slower ventricular rate ( 82 + /- 15 beats/min in the amiodarone group vs. 91 + /- 23 beats/min in the control group , p = 0.022 ) . After restoration of sinus rhythm , atrial fibrillation recurred during a 15-day follow-up period in 4 ( 12 % ) of 34 patients ( 95 % CI 3 % to 27 % ) in the amiodarone group and in 3 ( 10 % ) of 30 ( 95 % CI 2 % to 26 % ) in the control group ( p = 0.861 ) . CONCLUSIONS Intravenous amiodarone , at the doses used in this study , produces a modest but not significant benefit in converting acute atrial fibrillation to sinus rhythm 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 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 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 In a single-blind r and omized study , the efficacy of intravenous flecainide ( 2 mg/kg/10 minutes ) versus verapamil ( 10 mg/1 minute ) was assessed in 40 patients with paroxysmal atrial fibrillation ( AF ) or atrial flutter ( AFI ) . The treatment was considered successful if sinus rhythm occurred within 1 hour . Of 20 patients receiving flecainide , 14 of 17 ( 82 % ) with AF converted to sinus rhythm , but in 3 patients with AFI flecainide failed . All patients treated with verapamil ( 17 AF , 3 AFI ) showed lower ventricular rates after 1 hour ; however , only 1 ( 6 % ) with AF converted to sinus rhythm and 1 ( 6 % ) converted to AFI . Patients who did not convert to sinus rhythm after treatment with verapamil were treated with flecainide and observed for another hour . After the change to flecainide , 9 of 15 patients ( 60 % ) with AF still converted . Thus , 23 of 32 patients ( 72 % ) with AF and none of 7 with AFI converted to sinus rhythm after treatment with flecainide .  Conversion to sinus rhythm was achieved in 19 of 22 patients ( 86 % ) when AF lasted less than 24 hours and in 4 of 10 ( 40 % ) when the arrhythmia lasted greater than 24 hours . Transient adverse effects were noted in 10 patients ( 26 % ) after flecainide . In summary , flecainide is an effective and safe drug for conversion of paroxysmal AF to sinus rhythm , but ineffective for AFI . Verapamil appears to be of no use for conversion of AF or AFI to sinus rhythm 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 OBJECTIVES This r and omized double-blind study compared the efficacy and safety of intravenous vernakalant and amiodarone for the acute conversion of  recent-onset atrial fibrillation ( AF ) .  BACKGROUND Intravenous vernakalant has effectively converted recent-onset AF and was well tolerated in placebo-controlled studies . METHODS A total of 254 adult patients with AF ( 3 to 48 h duration ) eligible for cardioversion were enrolled in the study . Patients received either a 10-min infusion of vernakalant ( 3 mg/kg ) followed by a 15-min observation period and a second 10-min infusion ( 2 mg/kg ) if still in AF , plus a sham amiodarone infusion , or a 60-min infusion of amiodarone ( 5 mg/kg ) followed by a maintenance infusion ( 50 mg ) over an additional 60 min , plus a sham vernakalant infusion . RESULTS Conversion from AF to sinus rhythm within the first 90 min ( primary end point ) was achieved in 60 of 116 ( 51.7 % ) vernakalant patients compared with 6 of 116 ( 5.2 % ) amiodarone patients ( p < 0.0001 ) . Vernakalant result ed in rapid conversion ( median time of 11 min in responders ) and was associated with a higher rate of symptom relief compared with amiodarone ( 53.4 % of vernakalant patients reported no AF symptoms at 90 min compared with 32.8 % of amiodarone patients ; p = 0.0012 ) . Serious adverse events or events leading to discontinuation of study drug were uncommon . There were no cases of torsades de pointes , ventricular fibrillation , or polymorphic or sustained ventricular tachycardia . CONCLUSIONS Vernakalant demonstrated efficacy superior to amiodarone for acute conversion of recent-onset AF . Both vernakalant and amiodarone were safe and well tolerated in this study . ( A Phase III Superiority Study of Vernakalant vs Amiodarone in Subjects With Recent Onset Atrial Fibrillation [ AVRO ] ; NCT00668759 ) Objective Ibutilide , a class III antiarrhythmic drug , has been shown to convert atrial fibrillation to sinus rhythm more rapidly than procainamide or sotalol . Our objective was to compare the efficacy and safety of ibutilide and amiodarone in patients after cardiac surgery . Design Prospect i ve , r and omized , double-blinded study . Setting Intensive care unit of a university hospital . Patients Forty adults with an onset of atrial fibrillation within 3 hrs after admission . Interventions Before the administration of antiarrhythmic drugs , a 24-hr Holter electrocardiograph was attached . Patients in the ibutilide group received ibutilide 0.008 mg/kg body weight over 10 mins ; treatment was repeated if atrial fibrillation or flutter persisted . If sinus rhythm was not achieved within 4 hrs , amiodarone 5 mg/kg was administered over 30 mins , followed by amiodarone 15 mg/kg over 24 hrs . Patients in the amiodarone group received amiodarone 5 mg/kg over 30 mins , followed by amiodarone 15 mg/kg over 24 hrs if atrial fibrillation or flutter continued . Measurements and Main Results Within the first 4 hrs , atrial fibrillation was converted in nine of 20 patients ( 45 % ) in group ibutilide and in ten of 20 patients ( 50 % ) in group amiodarone ( not significant ) . Mean time for conversion overall was 385 mins in group ibutilide and 495 mins in group amiodarone ( not significant ) . In group amiodarone , the protocol was discontinued in two patients because of severe arterial hypotension . Atrial fibrillation recurred in 11 of 20 patients ( 55 % ) in group ibutilide and in seven of 20 patients ( 35 % ) in group amiodarone ( not significant ) . Ventricular arrhythmia did not occur during the first 24 hrs of the protocol . Conclusions Ibutilide has no significant advantage over amiodarone for the conversion of atrial fibrillation to sinus rhythm in either time to conversion or conversion overall , but severe hypotension was not seen with ibutilide 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 BACKGROUND Pilsicainide is a newly synthesized antiarrhythmic agent with class Ic properties . Various antiarrhythmic agents have been used to convert atrial fibrillation ( AF ) to sinus rhythm or decrease the rate of relapse of AF . METHODS We r and omly assigned 62 patients with chronic AF to oral treatment of either a  placebo  ( 10 patients ) or  150 mg/day of pilsicainide ( 52 patients ) for 4 weeks before electrical cardioversion . Before oral administration of pilsicainide , 41 patients underwent transesophageal echocardiography  to investigate whether there was thrombus formation in the heart chambers . Patients without pharmacologic defibrillation underwent direct current cardioversion to restore sinus rhythm . After successful cardioversion , all patients continued to receive pilsicainide and were monitored for up to 2 years . RESULTS Before cardioversion , 11 patients in the pilsicainide group ( 21 % ) reverted to sinus rhythm . No patients in the placebo group reverted to sinus rhythm . Direct current cardioversion was performed in 51 patients ; however , 8 patients were not converted to sinus rhythm ( 5 patients receiving pilsicainide , 3 patients receiving placebo ) , and 3 patients needed intracardiac cardioversion to convert to sinus rhythm . Asymptomatic bradyarrhythmias were observed in 5 patients in the pilsicainide group . During the follow-up period , 33 patients ( 71 % ) in the pilsicainide group remained in sinus rhythm at 1 month ; this number decreased to 23 patients ( 49 % ) at 3 months , 20 ( 43 % ) at 6 months , 16 ( 34 % ) at 12 months , 16 ( 34 % ) at 18 months , and 16 ( 34 % ) at 24 months . All patients receiving placebo continued to receive placebo after the cardioversion , and AF recurred a few days after cardioversion in all cases . No independent discriminant variables were identified in the groups between maintenance and nonmaintenance of sinus rhythm . Although no serious side effects regarding pilsicainide have been documented , one patient died of acute myocardial infa rct ion , most likely not related to pilsicainide administration . CONCLUSIONS Pilsicainide is effective in restoring or maintaining sinus rhythm in patients with chronic AF lasting longer than an average duration of 22 months . No major adverse effects were observed BACKGROUND Patients with rheumatic heart disease and atrial fibrillation incur significant morbidity and mortality . It is not known which approach , rate control or maintenance of sinus rhythm might be most appropriate . The present study was undertaken to compare the strategy of ventricular rate control versus maintenance of sinus rhythm in rheumatic atrial fibrillation , and to evaluate the role of amiodarone in this patient population . METHODS AND RESULTS We prospect ively studied 144 patients with chronic rheumatic atrial fibrillation in a double-blind protocol -rhythm control ( group I : 48 patients each with amiodarone -group Ia ; and  placebo -group  Ib ) and compared the effects with the ventricular rate control ( group II ) by diltiazem ( n=48 , open-label ) . Direct current cardioversion was attempted in group I. The mean age of the study population was 38.6+/-10.3 years , left atrial size was 4.7+/-0.6 cm , atrial fibrillation duration was 6.1+/-5.4 years , and 72.9 % patients had undergone valvular interventions . At 1 year , 45 patients with sinus rhythm in group I compared to 48 patients in group II demonstrated significant increase in exercise to sinus rhythm time , had improvement in functional class and quality of life score . There was no difference in hospitalization rates , systemic bleeds or incidence of thromboembolism . Five patients died in group II but none in group I ( p=0.02 ) . In group I , 73/87 ( 83.9 % ) patients converted , and 45/86 ( 52.3 % ) patients maintained sinus rhythm at 1 year . Conversion rates were 38/43 ( 88.4 % ) with amiodarone versus 34/44 ( 77.3 % ) with placebo ( p=0.49 ) : corresponding rate for maintaining sinus rhythm was 29/42 ( 69.1 % ) versus 16/44 ( 36.4 % ) , p=0.008 respectively . CONCLUSIONS Maintenance of sinus rhythm appeared to be superior to ventricular rate control in patients with rheumatic atrial fibrillation in terms of an effect on mortality and morbidity . Sinus rhythm could be restored in the majority and amiodarone was superior to placebo in this regard The appropriate treatment for the restoration of sinus rhythm in patients with atrial fibrillation ( AF ) of recent onset is still the subject of controversy . In this prospect i ve , r and omized , single-blind , placebo-controlled clinical study , we investigated the effectiveness and safety of procainamide , propafenone , and amiodarone , administered intravenously , for the conversion of recent-onset AF . We enrolled 362 consecutive patients ( 183 men ; age 34 to 86 years ; mean 65+/-10 ) with AF duration of no > 48 hours . Of these patients , 89 were given procainamide , 91 propafenone , 92 amiodarone , and 90 placebo . Treatment was considered successful if conversion to sinus rhythm was achieved within the 24-hour study period . Baseline clinical characteristics were similar in the 4 groups . The treatment was successful in 61 of the 89 patients who received procainamide ( 68.53 % ; median time 3 hours ) , 73 of the 91 patients who received propafenone ( 80.21 % ; median time 1 hour ) , 82 of the 92 patients who received amiodarone ( 89.13 % ; median time 9 hours ) , and 55 of the 90 patients who received placebo ( 61.11 % ; median time 17 hours ; p<0.05 for all medicated groups vs placebo ; p<0.05 for amiodarone and propafenone vs procainamide ) . In conclusion , all 3 medications , when administered intravenously , are effective in the restoration of sinus rhythm in recent-onset AF . Amiodarone and propafenone are more effective whereas procainamide and propafenone are faster AIMS This study compared the efficacy and safety of intravenous dofetilide with amiodarone and placebo in converting atrial fibrillation or flutter to sinus rhythm . METHODS AND RESULTS One hundred and fifty patients with atrial fibrillation or flutter ( duration range 2 h-6 months ) were given 15-min intravenous infusions of 8 microg . kg(-1)of dofetilide ( n=48 ) , 5 mg . kg(-1)of amiodarone ( n=50 ) , or placebo ( n=52 ) and monitored continuously for 3 h. Sinus rhythm was restored in 35 % , 4 % , and 4 % of patients , respectively ( P<0.001 , dofetilide vs placebo;P = ns , amiodarone versus placebo ) . Dofetilide was more effective in atrial flutter than in atrial fibrillation ( cardioversion rates 75 % and 22 % , respectively;P=0.004 ) . The mean time to conversion with dofetilide was 55+/-15 min . Dofetilide prolonged the QTc interval ( + 16 % at 20 min ) . Amiodarone substantially decreased the ventricular rate in non-converters ( -18 beats . min(-1)at 30 min ) . Two patients given dofetilide ( 4 % ) had non-sustained ventricular tachycardias , and four ( 8 % ) had torsade de pointes , in one case requiring electrical cardioversion . CONCLUSION 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 UNLABELLED In a population of 417 hospitalized patients , the efficacy and safety of different drug regimens administered to convert atrial fibrillation ( AF ) of recent onset ( < or = 7 days duration ) to sinus rhythm were evaluated . All patients were in NYHA Class < or = 2 , and free of heart failure . They were r and omly allocated to treatment with placebo in 121 patients ; i.v . amiodarone , 5 mg/kg bolus , followed by 1.8 g/24 hours in 51 patients ; i.v . propafenone , 2 mg/kg bolus , followed by 0.0078 mg/kg/min in 57 patients ; p.o . propafenone , 600 mg p.o . in a single dose in 119 patients ; and p.o . flecainide , 300 mg p.o . in a single dose in 69 patients . All patients were continuously monitored by  Holter ECG  , and the number of conversions to sinus rhythm was measured at 1 , 3 , and 8 hours . RESULTS ( 1 ) I.v . propafenone result ed in a higher conversion rate within 1 hour compared with the oral loading regimens of propafenone or flecainide , but the conversion rates at 3 and 8 hours were comparable , approximately 75 % at 8 hours ; 2 ) i.v . amiodarone was not different from placebo until 8 hours when it was associated with 57 % of conversions ; ( 3 ) conversion to sinus rhythm at 8 hours was observed in 37 % of the placebo treated patients . Serious adverse effects occurred in few patients : two patients treated with flecainide and one treated with i.v . propafenone experienced left ventricular decompensation ; one patient treated with placebo and two treated with flecainide had atrial flutter with rapid ventricular response . In conclusion , single-dose , oral loading with propafenone or flecainide are acceptable alternatives to conventional drug regimens in selected hospitalized patients . In addition , the measure of a placebo effect is m and atory in studies of recent-onset AF 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 BACKGROUND Amiodarone and sotalol are commonly used for the maintenance of sinus rhythm , but the efficacy of these agents administered as high-dose infusions for rapid conversion of atrial fibrillation is unknown . Use in this context would facilitate drug initiation in patients in whom ongoing prophylactic therapy is indicated . METHODS We assessed the efficacy and safety of rapid high-dose intravenous infusions of amiodarone and sotalol for heart rate control and rapid reversion to sinus rhythm in patients who came to the emergency department with recent-onset symptomatic atrial fibrillation . Patients ( n = 140 ) were r and omized to receive 1.5mg/kg of sotalol infused in 10 minutes , 10mg/kg of amiodarone in 30 minutes , or 500 microg of digoxin in 20 minutes . Electrical cardioversion was attempted for patients not converting to sinus rhythm within 12 hours . RESULTS The rapid infusion of sotalol or amiodarone result ed in more rapid rate control than digoxin . Each of the 3 trial strategies result ed in similar rates of pharmacological conversion to sinus rhythm  ( amiodarone , 51 % ; sotalol , 44 % ; digoxin , 50 % ; P = not significant ) . The overall rates of cardioversion after trial drug infusion and defibrillation were high for all groups ( amiodarone , 94 % ; sotalol , 95 % , ; digoxin , 98 % ; P = not significant ) , but there was a trend toward a higher incidence of serious adverse reactions in the amiodarone group . CONCLUSION The rapid infusion of sotalol or amiodarone in patients with symptomatic recent-onset atrial fibrillation results in rapid control of ventricular rate . Even with high-dose rapid infusions , all 3 agents are associated with a poor overall reversion rate within 12 hours . Almost all patients were returned to sinus rhythm with a combination of pharmacological therapy and electrical cardioversion
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 .