No other antiarrhythmic showed a significant effect on mortality compared with controls .
Class IA , IC , and III drugs are effective in maintaining sinus rhythm but increase adverse effects , and class IA drugs may increase mortality
BACKGROUND A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm .
We performed a systematic review to determine the effect of long-term treatment with those drugs on death , embolisms , adverse effects , and atrial fibrillation recurrence .
A randomized placebo-controlled trial of pre-treatment and short- or long-term maintenance therapy with amiodarone supporting DC cardioversion for persistent atrial fibrillation.
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
No other antiarrhythmic showed a significant effect on mortality compared with controls .
Class IA , IC , and III drugs are effective in maintaining sinus rhythm but increase adverse effects , and class IA drugs may increase mortality
BACKGROUND A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm .
We performed a systematic review to determine the effect of long-term treatment with those drugs on death , embolisms , adverse effects , and atrial fibrillation recurrence .