Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .
Intravenous amiodarone in treatment of recent-onset atrial fibrillation: results of a randomized, controlled study.
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
Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .