Amiodarone in the Treatment of Atrial Fibrillation: New Perspectives from Clinical Trials

  • G. M. De Ferrari
  • B. Petracci
Conference paper


Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and both its incidence and the burden it lays on the health system are steadily increasing, primarily because of the increase in the elderly proportion of the population [1-3]. Among the diverse pharmacological agents potentially useful in restoring and maintaining sinus rhythm, amiodarone is characterized by both a multiplicity of sites of action and high efficacy. Several studies have supported the use of this compound [4]. Trials evaluating intravenous use of amiodarone have recently been reviewed in detail [5]. The present paper will briefly evaluate a small number of recent clinical studies supporting the use of oral amiodarone in preventing recurrent episodes of AF in the general population and in selected clinical settings.


Atrial Fibrillation Sinus Rhythm Open Heart Surgery Atrial Fibrillation Recurrence Postoperative Atrial Fibrillation 
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  1. 1.
    Kannel WB, Abbott RD, Savage DD et al (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham Study. N Engl J Med 306:1018–1022PubMedCrossRefGoogle Scholar
  2. 2.
    Feinberg WM, Blackshear JL, Laupacis A et al (1995) Prevalence, age, distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 155: 469–473PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart S, Maclntyre K, MacLeod MMC et al (2001) Trends in hospital activity, morbidity and case fatality related to atrial fibrillation in Scotland, 1986–1996. Eur Heart J 22:1986–1996PubMedCrossRefGoogle Scholar
  4. 4.
    Nichol G, McAlister F, Pham B et al (2002) Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 87:535–543PubMedCrossRefGoogle Scholar
  5. 5.
    Hilleman DE, Spinier SA (2002) Conversion of recent onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials. Pharmacotherapy 22:66–74PubMedCrossRefGoogle Scholar
  6. 6.
    Roy D, Talajc M, Dorian P et al (2000) Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 342:913–920PubMedCrossRefGoogle Scholar
  7. 7.
    Lumer GB, Roy D, Talajc M et al (2002) Amiodarone reduces procedures and costs related to atrial fibrillation in a controlled clinical trial. Eur Heart J 23:1050–1056PubMedCrossRefGoogle Scholar
  8. 8.
    Waldo A (2000) Presentation at the late breaking session, 23rd Annual Scientific Session of the North American Society of Pacing and Electrophysiology, San Diego, May 2002Google Scholar
  9. 9.
    Madrid AH, Bueno MG, Rebollo JMG et al (2002) Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation. A prospective and randomized study. Circulation 106:331–336PubMedCrossRefGoogle Scholar
  10. 10.
    Nakashima H, Kumagai K, Urata H et al (2000) Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 101:2612–2617PubMedCrossRefGoogle Scholar
  11. 11.
    Alessie MA (1998) Atrial electrophysiological remodeling: another vicious circle? J Cardiovasc Electrophysiol 9:1378–1393CrossRefGoogle Scholar
  12. 12.
    Pedersen OD, Bagger H, Kober L et al (1999) Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 100:376–380PubMedCrossRefGoogle Scholar
  13. 13.
    Mathew JP, Parks R, Savino JS et al (1996) Atrial fibrillation following coronary bypass graft surgery. JAMA 276:300–306PubMedCrossRefGoogle Scholar
  14. 14.
    Lynn GM, Stefanko K, Reed JF et al (1992) Risk factors for stroke after coronary artery bypass. J Thorac Cardiovasc Surg 104:1518–1523PubMedGoogle Scholar
  15. 15.
    Kowey PR, Taylor JE, Rials SJ et al (1992) Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary bypass grafting. Am J Cardiol 69:963–965PubMedCrossRefGoogle Scholar
  16. 16.
    Daoud EG, Strickberger A, Man KC et al (1997) Preoperative amiodarone as prophylaxis against atrial fibrillation after open heart surgery. N Engl J Med 337:1785–1791PubMedCrossRefGoogle Scholar
  17. 17.
    Redle JD, Khurana S, Marzan R et al (1999) Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary bypass surgery. Am Heart J 138:144–150PubMedCrossRefGoogle Scholar
  18. 18.
    Giri S, White CM, Dunn AB et al (2001) Oral amiodarone for prevention of atrial fibrillation after open heart surgery, the Atrial Fibrillation Suppression Trial (AFIST): a randomised placebo-controlled trial. Lancet 357:830–836PubMedCrossRefGoogle Scholar
  19. 19.
    Janse MJ, Malik M, Camm AJ, Julian DG, Frangin GA, Schwartz PJ on behalf of the EMIAT Investigators 1 (1998) Identification of post acute myocardial infarction patients with potential benefit from prophylactic treatment with amiodarone. A sub-study of EMIAT (the European Myocardial Infarct Amiodarone trial). Eur Heart J 19:85–95Google Scholar
  20. 20.
    De Ferrari GM, Tavazzi L (1999) The role of arrhythmias in the progression of heart failure. Eur J Heart Fail 1:35–40PubMedCrossRefGoogle Scholar
  21. 21.
    De Ferrari GM, Landolina M, Casella M et al (2001) Internal cardioversion of permanent atrial fibrillation in patient with severe heart failure: 1 year follow-up. Eur Heart J 22:562 (Abstract)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • G. M. De Ferrari
    • 1
  • B. Petracci
    • 1
  1. 1.Department of CardiologyIRCCS Policlinico San MatteoPaviaItaly

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