Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence
AIM To assess , through a systematic review , evidence for the effects of antiarrhythmic drugs ( AADs ) on  cardiovascular ( CV ) hospitalization and mortality .
Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation: a randomized trial.
CONTEXT Amiodarone effectively suppresses atrial fibrillation but causes many adverse events . OBJECTIVE To compare major events in patients r and omized to receive episodic amiodarone treatment with those who received continuous amiodarone treatment  while still aim ing to prevent atrial fibrillation . DESIGN , SETTING , AND PARTICIPANTS A r and omized trial of 209 ambulatory patients with recurrent symptomatic persistent atrial fibrillation , conducted from December 2002 through March 2007 at 7 Dutch medical centers . INTERVENTION Patients were r and omly assigned to receive either episodic or continuous amiodarone treatment after electrical cardioversion following amiodarone loading . Episodic amiodarone treatment was discontinued after a month of sinus rhythm and reinitiated if atrial fibrillation relapsed ( 1 month peri-electrical cardioversion ) . In the continuous treatment group amiodarone was maintained throughout . MAIN OUTCOME MEASURES The primary end point was a composite of amiodarone and underlying heart disease-related major events . The secondary end points were all-cause mortality and cardiovascular hospitalizations . RESULTS After a median follow-up of 2.1 years ( range , 0.4 - 2.5 years ) , 51 ( 48 % ) of those receiving episodic treatment vs 64 ( 62 % ) receiving continuous treatment had sinus rhythm ( P = .05 ) . There were 85 atrial fibrillation recurrences ( 80 % ) among the episodic treatment group vs 56 ( 54 % ) in the continuous treatment group ( P < .001 ) . No significant difference existed in the incidence of the primary composite end point between each group ( 37 [ 35 % ] episodic vs 34 [ 33 % ] continuous ; incidence rate difference , 0.2 ; 95 % confidence interval [ CI ] , -10.2 to 10.6 ) . However , there were nonstatistically significant differences in the incidence of amiodarone-related major events ( 20 [ 19 % ] episodic vs 25 [ 24 % ] continuous ; incidence rate difference , -2.0 ; 95 % CI , -8.7 to 4.6 ) and underlying heart disease-related major events ( 17 [ 16 % ] episodic vs 9 [ 9 % ] continuous ; incidence rate difference , 3.6 ; 95 % CI , -1.6 to 8.7 ) . All-cause mortality and cardiovascular hospitalizations were higher among those receiving episodic treatment ( 56 [ 53 % ] vs 35 [ 34 % ] , P = .02 ) . CONCLUSIONS In this study population , there was no difference in the composite of amiodarone and cardiac major adverse events between groups . However , patients receiving episodic treatment had a significantly increased rate of atrial fibrillation recurrence and a significantly higher rate of all-cause mortality and cardiovascular hospitalizations . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00392431
Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence
AIM To assess , through a systematic review , evidence for the effects of antiarrhythmic drugs ( AADs ) on  cardiovascular ( CV ) hospitalization and mortality .