Direct current electrical cardioversion (DEC) for persistent atrial fibrillation (AF) carries a very high initial success rate of up to 95%, but as few as 23% of patients remain in sinus rhythm one year post-procedure, with most recurrences of AF occurring within the first five days.¹ Amiodarone has emerged as the most effective agent at preventing relapse of AF post-DEC, with up to 69% of patients remaining in sinus rhythm at one year.² However, as many as 25% of amiodarone treated patients are forced to discontinue treatment because of side effects of the drug.³ Thus, increasing efforts have been made to improve the success rates for maintenance of sinus rhythm post-DEC, without exposing patients to the potentially toxic side effects of prolonged antiarrhythmic treatment. In this study we investigated whether a short four week course of oral amiodarone, pericardioversion for persistent AF, would improve medium and longer term sinus rhythm maintenance, without the significant drug side effects associated with prolonged amiodarone usage.

METHODS

The study recruited a cohort of 35 patients in persistent AF, > 1 month duration without a reversible cause, referred for DEC. The patients were randomised (unblinded) into two groups. Group A received a total of four weeks treatment with oral amiodarone according to the following schedule: 200 mg three times daily for one week before DEC, followed by 200 mg three times daily during week 2, 200 mg twice daily during week 3, then 200 mg once a day for week 4. Group B continued with the usual treatment but did not receive amiodarone or any other antiarrhythmic therapy.

The cardioversion protocol consisted …