Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation

doi:10.1016/S0002-9149(99)00789-4

The American Journal of Cardiology

Volume 85, Issue 4, 15 February 2000, Pages 462-465

https://doi.org/10.1016/S0002-9149(99)00789-4 Get rights and content

Abstract

The efficacy of amiodarone has been proved in long-term maintenance of sinus rhythm (SR) in patients with paroxysmal atrial fibrillation (AF). The present study evaluates the efficacy and safety of a single oral dose of amiodarone in patients with recent-onset AF (<48 hours). Seventy-two patients were randomized to receive 30 mg/kg of either amiodarone or placebo. Conversion to SR was verified by 24-hour Holter monitoring. Ten patients were excluded because of SR in the beginning of monitoring or technical failure during Holter monitoring. The remaining study groups were comparable (n = 31 for each), except that in the placebo group β blockers were more common. The patients receiving amiodarone converted to SR more effectively than those receiving placebo (p <0.0001). At 8 hours, approximately 50% of patients in the amiodarone group and 20% in the placebo group (Holter successful) had converted to SR, whereas after 24 hours the corresponding figures were 87% and 35%, respectively. The median time for conversion (8.7 hours for amiodarone and 7.9 hours for placebo) did not differ in the groups. Amiodarone was hemodynamically well tolerated, and the number of adverse events in the study groups was similar. Amiodarone as a single oral dose of 30 mg/kg appears to be effective and safe in patients with recent-onset AF.

Section snippets

Patients and study design

Patients aged >18 years were eligible when they (1) had recent-onset AF (<48 hours) continuing for >3 hours in the hospital, (2) had a ventricular rate >50 and <150 beats/min, (3) were hemodynamically stable (systolic blood pressure >95 mm Hg), and (4) had a normal serum potassium level (>3.5 mmol/L). Patients with known thyroid disease, with a history of acute myocardial infarction, acute pulmonary edema, known sick sinus syndrome, or high-degree atrioventricular block were excluded, as were

Patients

Ten of the 72 patients fullfilling the entry criteria were excluded from final analysis: 5 because of technical failure and 5 because of having SR at the beginning of Holter monitoring. Of the 62 patients remaining in the analysis, 31 belonged to each group. The patient characteristics and the medication use before hospitalization for AF are listed in Table I. The groups did not differ except that use of β-blocking agents was more common in the placebo group. Patients in the placebo group

Discussion

Numerous trials have tested the efficacy of antiarrhythmic drugs in conversion of recent-onset atrial fibrillation to SR.12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 Flecainide, either given intravenously or as a single oral dose, has been shown to be highly effective and to act relatively quickly. The efficacy rates ranging from 59% to 93% for the intravenous route and from 56% to 81% for the oral route have been reported.23 Propafenone is relatively effective as well. With intravenous and

References (29)

M Noc et al.
Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm
Am J Cardiol
(1990)
H.F McAlister et al.
Intravenous amiodarone bolus versus oral quinidine for atrial flutter and fibrillation after cardiac operations
J Thorac Cardiovasc Surg
(1990)
K.D Donovan et al.
Intravenous flecainide versus amiodarone for recent-onset atrial fibrillation
Am J Cardiol
(1995)
B Escoubet et al.
Suppression of arrhythmias within hours after a single oral dose of amiodarone and relation to plasma and myocardial concentrations
Am J Cardiol
(1985)
K.K Teo et al.
Sotalol infusion in the treatment of supraventricular tachyarrhythmias
Chest
(1985)
A Borgeat et al.
Flecainide versus quinidine for cardioversion of atrial fibrillation to sinus rhythm
Am J Cardiol
(1986)
L Bianconi et al.
Effectiveness of intravenous propafenone for conversion of atrial fibrillation and flutter of recent onset
Am J Cardiol
(1989)
N.D Mostow et al.
Rapid control of refractory atrial tachyarrhythmias with high-dose oral amiodarone
Am Heart J
(1990)
M.J Suttorp et al.
The value of class Ic antiarrhythmic drug for conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm
J Am Coll Cardiol
(1990)
K.D Donovan et al.
Reversion of recent-onset atrial fibrillation to sinus rhythm by intravenous flecainide
Am J Cardiol
(1991)

L.J Repique et al.

Atrial fibrillation 1992management strategies in flux

Chest

(1992)

A Capucci et al.

Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide

Am J Cardiol

(1994)

J.J Heger et al.

Plasma and red blood cell concentration of amiodarone during chronic therapy

Am J Cardiol

(1984)

H.C Doval et al.

Randomised trial of low-dose amiodarone in severe congestive heart failure

Lancet

(1994)

Cited by (61)

Dataset for amiodarone adverse events compared to placebo using data from randomized controlled trials
2020, Data in Brief
The dataset presented here provides a detailed description of the adverse events of amiodarone versus placebo using data from 43 randomized controlled trials. Two authors (M.M., M.R.) independently extracted the data. The dataset also includes baseline patient characteristics, amiodarone loading and maintenance doses, as well as forest plots describing the relative risk (RR) of developing an adverse event related to the pulmonary, thyroid, hepatic, cardiac, skin, gastrointestinal, neurological, and ocular systems. The Mantel-Haenszel random effects model was used to determine the relative risk of adverse events of amiodarone compared to placebo. This dataset is complementary to our article “Meta-analysis Comparing the Relative Risk of Adverse Events for Amiodarone Versus Placebo”, which was published in the American Journal of Cardiology [1]. The data can be used to assess certain adverse events and their relation to amiodarone loading and/or maintenance dose.
Atrial fibrillation
2012, Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease: Fourth Edition
2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
2011, Journal of the American College of Cardiology
Pharmacologic Conversion of Atrial Fibrillation and Atrial Flutter
2010, Cardiac Electrophysiology Clinics
Acute management of atrial fibrillation
2009, Chest
Citation Excerpt :
Amiodarone is a class III AAD that is frequently used in the critical care clinical setting. There have been RCTs and a meta-analysis of RCTs to assess the efficacy of amiodarone in comparison to placebo and other antiarrhythmic agents (Table 5).40–46 The comparison of the efficacy of amiodarone and flecainide has been discussed previously.
Acute atrial fibrillation (AF) is the most common cardiac rhythm encountered in clinical practice and is commonly seen in acutely ill patients in critical care. In the latter setting, AF may have two main clinical sequelae: (1) haemodynamic instability and (2) thromboembolism. The approach to the management of AF can broadly be divided into a rate control strategy or a rhythm control strategy, and is largely driven by symptom assessment and functional status. A crucial part of AF management requires the appropriate use of thromboprophylaxis. In patients who are haemodynamically unstable with AF, urgent direct current cardioversion should be considered. Apart from electrical cardioversion, drugs are commonly used, and Class I (flecainide, propafenone) and Class III (amiodarone) antiarrhythmic drugs are more likely to revert AF to sinus rhythm. Beta blockers and rate limiting calcium blockers, as well as digoxin, are often used in controlling heart rate in patients with acute onset AF. The aim of this review article is to provide an overview of the management of AF in the critical care setting.
Intravenous and oral administration of amiodarone for the treatment of recent onset atrial fibrillation after digoxin administration
2007, International Journal of Cardiology
Citation Excerpt :
On the other hand, more recent data showed the opposite: Galve et al. found no significant difference regarding conversion to sinus rhythm between 5 mg/kg amiodarone given as a 30-min infusion followed by 1200 mg over 24 h and placebo [5]. Kreiss et al. showed a success rate of 55% with the use of IV amiodarone in recent onset < 48 h AF population, whereas Peuhkurinen et al. recorded a success rate of 87% with a mean time of 7.9 h of cardioversion of recent onset AF when using oral amiodarone [11,12]. Comparative studies of amiodarone and flecainide have not demonstrated any clear superiority of either drug in conversion rates of recent onset AF to date.
Atrial fibrillation (AF) remains a significant contributor to cardiovascular morbidity. Amiodarone is a potent antiarrhythmic drug. The safety and efficacy of oral versus intravenous (IV) Amiodarone in the treatment of AF of recent onset (duration < 48 h) was investigated.
The study population consisted of 223 patients with symptomatic AF, of whom 110 received 600 mg oral Amiodarone (Group A) in three divided doses and 113 received IV Amiodarone (5 mg/kg over 30 min followed by 1000 mg over the next 24 h) (Group B). Digoxin was administered to all patients, who had not previously received it. All patients were monitored for 24 h.
Conversion to sinus rhythm occurred in 85.45% of group A and 82.30% in group B (p = NS). Mean time of cardioversion in group A was 20 ± 4.5 h and in group B was 12 ± 8 h (p < 0,001). However, blood pressure (BP) in group A remained stable for the observation period, whereas it fell significantly in group B. Treatment was not discontinued in any of the patients in either group, however 13 patients in group B developed superficial phlebitis.
Both forms of the drug are extremely efficient in restoring sinus rhythm in AF of recent onset, although the IV form acts quicker. The oral form of the drug does not alter significantly the patients' BP.

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^☆: This study was supported by a grant from Sanofi Winthrop Company, Helsinki, Finland. Manuscript received June 14, 1999; revised manuscript received September 23, 1999, and accepted September 25.

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Arrhythmias and Conduction DisturbancesEffectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation☆

Abstract

Section snippets

Patients and study design

Patients

Discussion

Am J Cardiol

J Thorac Cardiovasc Surg

Am J Cardiol

Am J Cardiol

Chest

Am J Cardiol

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Am J Cardiol

Chest

Am J Cardiol

Am J Cardiol

Lancet

Arrhythmias and Conduction Disturbances
Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation☆