Heart 2000;84:251-257 ( September )

Cardiovascular medicine

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study G E Kochiadakis, N E Igoumenidis, M E Marketou, M D Kaleboubas, E N Simantirakis, P E Vardas

Cardiology Department, University Hospital of Heraklion, PO Box 1352, Heraklion, Crete, Greece

Correspondence to: Professor P E Vardas email: cardio{at}med.uoc.gr

Accepted 10 April 2000

OBJECTIVETo assess and compare the safety and efficacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation.
DESIGNProspective, randomised, single blind, placebo controlled study.
SETTINGTertiary cardiac referral centre.
PATIENTS186 consecutive patients (97 men, 89 women; mean (SD) age, 63 (10) years) with recurrent, symptomatic atrial fibrillation.
INTERVENTIONS65 patients were randomised to amiodarone, 61 to sotalol, and 60 to placebo. Patients receiving amiodarone were maintained at a dose of 200 mg/day after a 30 day loading phase. The sotalol dose was 160-480 mg daily, as tolerated.
MAIN OUTCOME MEASURESRecurrence of atrial fibrillation or side effects.
RESULTSIn the amiodarone group, 31 of the 65 patients developed atrial fibrillation after an average of six months, while 15 (11 in sinus rhythm and four in atrial fibrillation) experienced significant side effects after an average of 16 months. In the sotalol group, relapse to atrial fibrillation occurred in 47 of the 61 patients after an average of eight months; three experienced side effects during the titration phase. In the placebo group, 53 of the 60 patients developed atrial fibrillation after an average of four months (p < 0.001 for amiodarone and sotalol v placebo; p < 0.001 for amiodarone v sotalol).
CONCLUSIONSBoth amiodarone and sotalol can be used for the maintenance of normal sinus rhythm in patients with symptomatic atrial fibrillation. Amiodarone is more effective but causes more side effects.


Keywords: amiodarone; sotalol; atrial fibrillation

---

© 2000 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Piccini, J. P., Hasselblad, V., Peterson, E. D., Washam, J. B., Califf, R. M., Kong, D. F. (2009). Comparative efficacy of dronedarone and amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation.. J Am Coll Cardiol 54: 1089-1095 [Abstract] [Full Text]  
• Verma, A. (2009). Alternatives to amiodarone: search for the Holy Grail. Europace 11: 402-404 [Full Text]  
• Doyle, J. F., Ho, K. M. (2009). Benefits and Risks of Long-term Amiodarone Therapy for Persistent Atrial Fibrillation: A Meta-analysis. Mayo Clin Proc. 84: 234-242 [Abstract] [Full Text]  
• Vassallo, P., Trohman, R. G. (2007). Prescribing Amiodarone: An Evidence-Based Review of Clinical Indications. JAMA 298: 1312-1322 [Abstract] [Full Text]  
• Sulke, N, Sayers, F, Lip, G Y H, on behalf of the Guideline Development Group for t, (2007). Rhythm control and cardioversion. Heart 93: 29-34 [Full Text]  
• Lombardi, F., Borggrefe, M., Ruzyllo, W., Luderitz, B., for the A-COMET-II Investigators, (2006). Azimilide vs. placebo and sotalol for persistent atrial fibrillation: the A-COMET-II (Azimilide-CardiOversion MaintEnance Trial-II) trial. Eur Heart J 27: 2224-2231 [Abstract] [Full Text]  
• Writing Committee Members, , Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8: 651-745 [Full Text]  
• Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S. (2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society . J Am Coll Cardiol 48: e149-e246 [Full Text]  
• Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA TASK FORCE MEMBERS, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC COMMITTEE FOR PRACTICE GUIDELINES, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114: e257-e354 [Full Text]  
• Lafuente-Lafuente, C., Mouly, S., Longas-Tejero, M. A., Mahe, I., Bergmann, J.-F. (2006). Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials.. Arch Intern Med 166: 719-728 [Abstract] [Full Text]  
• Gulizia, M., Mangiameli, S., Chiaranda, G., Spadola, V., Di Giovanni, N., Colletti, A., Bulla, V., Circo, A., Pensabene, O., Vasquez, L., Vaccaro, I., Grammatico, A., on behalf of PITAGORA Study Investigators, (2006). Design and rationale of a randomized study to compare amiodarone and Class IC anti-arrhythmic drugs in terms of atrial fibrillation treatment efficacy in patients paced for sinus node disease: the PITAGORA trial.. Europace 8: 302-305 [Abstract] [Full Text]  
• Capucci, A., Aschieri, D. (2003). Antiarrhythmic drug therapy: what is certain and what is to come. Eur Heart J Suppl 5: H8-H18 [Abstract]  
• Letelier, L. M., Udol, K., Ena, J., Weaver, B., Guyatt, G. H. (2003). Effectiveness of Amiodarone for Conversion of Atrial Fibrillation to Sinus Rhythm: A Meta-analysis. Arch Intern Med 163: 777-785 [Abstract] [Full Text]  
• Shinagawa, K., Shiroshita-Takeshita, A., Schram, G., Nattel, S. (2003). Effects of Antiarrhythmic Drugs on Fibrillation in the Remodeled Atrium: Insights Into the Mechanism of the Superior Efficacy of Amiodarone. Circulation 107: 1440-1446 [Abstract] [Full Text]  
• (2003). Using oral amiodarone. DTB 41: 9-12 [Abstract] [Full Text]  
• Essebag, V., Hadjis, T., Platt, R. W., Pilote, L. (2003). Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior myocardial infarction. J Am Coll Cardiol 41: 249-254 [Abstract] [Full Text]  
• (2001). Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J 22: 1852-1923  
• Fuster, V., Ryden, L. E., Asinger, R. W., Cannom, D. S., Crijns, H. J., Frye, R. L., Halperin, J. L., Kay, G. N., Klein, W. W., Levy, S., McNamara, R. L., Prystowsky, E. N., Wann, L. S., Wyse, D. G., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., Hiratzka, L. F., Jacobs, A. K., Russell, R. O., Smith, S. C. Jr, Klein, W. W., Alonso-Garcia, A., Blomstrom-Lundqvist, C., De Backer, G., Flather, M., Hradec, J., Oto, A., Parkhomenko, A., Silber, S., Torbicki, A. (2001). ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 38: 1266-1266 [Full Text]  
• Coumel, P. (2001). Sotalol: a fool's deal?. Eur Heart J 22: 1370-1373  
• Yarnall, S. R (2001). Amiodarone maintained sinus rhythm better than sotalol or placebo in atrial fibrillation, but adverse effects were more frequent. Evid. Based Med. 6: 42-42 [Full Text]