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Previous Volume 342:913-920 March 30, 2000 Number 13 Next

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ABSTRACT

Background The restoration and maintenance of sinus rhythm is a desirable goal in patients with atrial fibrillation, because the prevention of recurrences can improve cardiac function and relieve symptoms. Uncontrolled studies have suggested that amiodarone in low doses may be more effective and safer than other agents in preventing recurrence, but this agent has not been tested in a large, randomized trial.

Methods We undertook a prospective, multicenter trial to test the hypothesis that low doses of amiodarone would be more efficacious in preventing recurrent atrial fibrillation than therapy with sotalol or propafenone. We randomly assigned patients who had had at least one episode of atrial fibrillation within the previous six months to amiodarone or to sotalol or propafenone, given in an open-label fashion. The patients in the group assigned to sotalol or propafenone underwent a second randomization to determine whether they would receive sotalol or propafenone first; if the first drug was unsuccessful the second agent was prescribed. Loading doses of the drugs were administered and electrical cardioversion was performed (if necessary) within 21 days after randomization for all patients in both groups. The follow-up period began 21 days after randomization. The primary end point was the length of time to a first recurrence of atrial fibrillation.

Results Of the 403 patients in the study, 201 were assigned to amiodarone and 202 to either sotalol (101 patients) or propafenone (101 patients). After a mean of 16 months of follow-up, 71 of the patients who were assigned to amiodarone (35 percent) and 127 of those who were assigned to sotalol or propafenone (63 percent) had a recurrence of atrial fibrillation (P<0.001). Adverse events requiring the discontinuation of drug therapy occurred in 18 percent of the patients receiving amiodarone, as compared with 11 percent of those treated with sotalol or propafenone (P=0.06).

Conclusions Amiodarone is more effective than sotalol or propafenone for the prevention of recurrences of atrial fibrillation.

Source Information

From the Montreal Heart Institute, Montreal (D.R., M.T., M.J.E., J.L., M.D., P.G., S.N., B.T.); St. Michael's Hospital, Toronto (P.D.); Hamilton General Hospital and McMaster University, Hamilton, Ont. (S.C.); the University of Ottawa Heart Institute, Ottawa, Ont. (M.G.); and Hôpital du Sacré-Cur de Montréal, Montreal (T.K.) — all in Canada.

Address reprint requests to Dr. Roy at the Montreal Heart Institute, 5000 Belanger St. E., Montreal, QC H1T 1C8, Canada, or at roy{at}icm.umontreal.ca.

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Amiodarone to Prevent Recurrence of Atrial Fibrillation
Aggarwal A., Furmaga E. M., Good C. B., Talajic M., Roy D., Lambert J.
Extract | Full Text  
N Engl J Med 2000; 343:578-580, Aug 24, 2000. Correspondence

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