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* From the Cardiology Department (Drs. Vardas, Kochiadakis, Igoumenidis, Simantirakis, and Chlouverakis) and the Unit of Toxicology (Dr. Tsatsakis), Heraklion University Hospital, Crete, Greece.
Correspondence to: Panos E. Vardas, MD, PhD, Cardiology Department, Heraklion University Hospital, PO Box 1352 Stavrakia, Heraklion, Crete, Greece; e-mail: cardio{at}med.uoc.gr
Study objectives: To investigate the efficacy and safety of amiodarone administered as the drug of first choice in the conversion of atrial fibrillation, regardless of its duration.
Design: Prospective, randomized, controlled clinical study.
Setting: Tertiary cardiac referral center.
Patients: Two-hundred eight consecutive patients (102 men; mean [± SD] age, 65 ± 10 years) with atrial fibrillation.
Interventions: One-hundred eight patients received amiodarone, and 100 patients received placebo treatment. Patients randomized to amiodarone received 300 mg IV for 1 h, and then 20 mg/kg for 24 h. They were also given 600 mg/d orally, divided into three doses, for 1 week, and thereafter 400 mg/d for 3 weeks. Patients randomized to placebo treatment received an identical amount of saline solution IV over 24 h, and oral placebo treatment for 1 month.
Measurements and results: Baseline clinical characteristics were similar in the two groups. Conversion to sinus rhythm was achieved in 87 of 108 patients (80.05%) who received amiodarone, and in 40 of 100 patients (40%) in the placebo group (p < 0.0001). Statistical analysis showed that the duration of the arrhythmia and the size of the left atrium affected both the likelihood of conversion to sinus rhythm and the time to conversion in both groups. No side effects requiring discontinuation of treatment were observed in either group.
Conclusions: Amiodarone appears to be safe and effective in the termination of atrial fibrillation. However, extreme cases with a large left atrium and long-lasting arrhythmia need long-term therapy.
Key Words: amiodarone • atrial fibrillation • cardioversion • left atrial diameter
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