Intravenous flecainide versus Amiedarone fof recent-onset atrial fibrillation

Intravenous amiodarone for cardioversion of recent‐onset atrial fibrillation

“…It has been shown in other studies that the efficacy of amiodarone in the termination of AF of different duration is significantly lower than that of class Ic drugs when assessed within the first 3 h of treatment. 6,11,14 In our study, the difference between efficacy of amiodarone and control treatment started to be significant after 8 h of treatment, when 50% of patients receiving amiodarone were converted to sinus rhythm. This is not surprising because intravenous amiodarone exerts different electrophysiologic effects than oral formulation.…”

“…Until the present, there have been four reports on the efficacy of amiodarone in the set-ting of new-onset AF, but the numbers of patients were relatively small and the reported amiodarone efficacy varied from 59 to 92% of patients. [6][7][8][9] The purpose of the present study was to assess the efficacy of intravenous amiodarone in conversion of AF in a randomized, single-blind, multicenter trial.…”

Evidence-Based Analysis of Amiodarone Efficacy and Safety

“…64 Control of ventricular rate in AF was evaluated in 2 placebocontrolled studies, both of which reported significantly lower ventricular rates with amiodarone. 69,70 Thus, amiodarone is effective for acute conversion of AF and has a beneficial effect on heart rate in AF.…”

“…In 1 of these studies, amiodarone and flecainide had similar rates of conversion. 70 Two studies of intravenous amiodarone and propafenone in postoperative AF of 40 and 84 patients, respectively, observed little difference between drugs, although there was a small trend in each study in favor of amiodarone at 24 hours with conversion rates of 67% versus 77% (PϭNS) 75 and 68% versus 83% (PϭNS). 76 Interestingly, in both studies, early (1 hour) conversion rates were significantly better with propafenone, suggesting a more delayed onset of action with amiodarone.…”

Part 6: Advanced Cardiovascular Life Support : Section 5: Pharmacology I: Agents for Arrhythmias

“…Therefore, in patients at risk for systemic emboli, amiodarone is recommended only when other medications for rate control have proved ineffective or are contraindicated and the risk of possible pharmacological cardioversion is felt to be justified. Some studies have found that whereas amiodarone was effective for rate control, conversion to sinus rhythm was no greater with conventional doses of IV amiodarone than placebo or digitalis, [55][56][57][58][59][60][61][62][63][64][65][66][67]160 particularly in refractory AF and clinical shock. Because of this concern amiodarone should be reserved for use within the first 48 hours of arrhythmia onset 62,78 or in patients in whom other rate-control measures are ineffective or contraindicated.…”