Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation
Abstract
The efficacy and safety of amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation was examined by reviewing the trials on the subject identified through a comprehensive literature search. Amiodarone has been used both intravenously (i.v.) and orally for the pharmacological cardioversion of recent-onset atrial fibrillation. Intravenous amiodarone has been used as a bolus only or as a bolus followed by a continuous i.v. infusion until conversion or up to 24 h. The dose of i.v. bolus given ranged from 3 to 7 mg/kg body weight and that of infusion from 900 to 3000 mg/day. The efficacy reported is 34-69% with the bolus only regimens, and 55-95% with the bolus followed by infusion regimens. Only the higher dose (>1500 mg/day) amiodarone is superior to placebo in converting recent-onset atrial fibrillation to sinus rhythm. The highest 24-h conversion rates have been reported with the i.v. regimen of 125 mg/h until conversion or a maximum of 3 g and the oral regimen of 25-30 mg/kg body weight administered as a single loading-dose (>90% and >85%, respectively). Most of the conversions occur after 6-8 h of the initiation of therapy. Predictors of successful conversion are shorter duration of atrial fibrillation, smaller left atrial size, and higher amiodarone dose. Amiodarone is not superior to the other antiarrhythmic drugs conventionally used for the pharmacological cardioversion of recent-onset atrial fibrillation but is relatively safe in patients with structural heart disease and in those with depressed left ventricle function. Therefore, amiodarone could be used particularly in patients with structural heart disease and in those with left ventricular systolic dysfunction as the use of class IC drugs, propafenone and flecainide, for cardioversion of atrial fibrillation is contraindicated in such patients.
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Amiodarone is more effective in preventing atrial fibrillation recurrences than other antiarrhythmic drugs.
“Amiodarone is more effective in preventing AF recurrences than other antiarrhythmic drugs but extracardiac toxic effects are common and increase with time.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [598]
Extracardiac toxic effects of amiodarone are common and increase with time.
“Amiodarone is more effective in preventing AF recurrences than other antiarrhythmic drugs but extracardiac toxic effects are common and increase with time.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [598]
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- Authors
- Khan, I. A., Mehta, N. J., & Gowda, R. M.
- Affiliations
- Creighton University (US)
- Corresponding author
- Khan, Ijaz A.
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2003-06
- Volume
- 89
- Issue
- 2-3
- Pages
- 239-248
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2043107235
- Cited by
- 94
- References
- 29
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 10 · 2015: 5 · 2014: 5 · 2013: 4 · 2012: 5
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- amiodarone, pharmacological cardioversion, recent-onset atrial fibrillation, intravenous bolus, continuous intravenous infusion, oral amiodarone, conversion to sinus rhythm, predictors of conversion, structural heart disease, left ventricular systolic dysfunction, antiarrhythmic drugs, propafenone, flecainide
- MeSH terms
- Administration, Oral, Amiodarone, Anti-Arrhythmia Agents, Atrial Fibrillation, Clinical Trials as Topic, Electric Countershock, Heart Diseases, Humans, Infusions, Intravenous, Systole, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left
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