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Pharmacologic Reversion of Persistent Atrial Fibrillation with Amiodarone Predicts Long-Term Sinus Rhythm Maintenance

Hospital Durand, Buenos Aires, Córdoba

Marcelo V. Elizari, MD, FACC

Pablo A. Chiale, MD

Remberto Torres Molina, MD

Hospital Ramos Mejía, Buenos Aires, Córdoba

Raúl Ledesma, MD

Instituto del Corazón, Córdoba

Angel O. Scapín, MD

Instituto del Corazón, Córdoba

Manuel Vázquez Blanco, MD, FACC

Grupo de Estudios Multicéntricos Argentinos (GEMA), Buenos Aires, Argentina

Ricardo Bonato, MD

Hospital de Clinicas, Buenos Aires, Argentina

Manuel Lago, MD

Hospital Ramos Mejía, Buenos Aires, Córdoba

Grupo de Estudio de Fibrilación Auricular Con Amiodarona (GEFACA) Investigators

Objective: The study analyzed the role of differentvariables that determine long-term sinus rhythm maintenance inpatients with persistent atrial fibrillation who are treated withamiodarone.

Background: It has been recognized that different factors influence long-term sinus rhythm preservation after the conversion of persistent atrial fibrillation. Although the duration of the arrhythmia appears to be the most important factor, consistent information regarding the role of the mode of arrhythmia conversion (pharmacologic or electric) is still lacking.

Methods: One hundred and forty one anticoagulated patients with persistent atrial fibrillation (median duration 8 months, percentiles 25 and 75: 2-24) were treated for 4 weeks with oral amiodarone (600 mg/day). Those in whom the arrhythmia persisted underwent electric cardioversion. After restoration of normal sinus rhythm (either pharmacologic or electric), all patients received a daily dose of amiodarone (200 mg) and were followed for a median of 19 months (percentiles 25 and 75: 8-34 months).

Results: Sixty eight patients (48.22%) regained sinus rhythm during the initial period of amiodarone treatment with 600 mg/day (Group I) and 73 (51.78%) required electric cardioversion (Group II). During the entire follow-up, atrial fibrillation relapsed in 63 patients: 17 (25%) in Group I and 46 (63%) in Group II. Recurrences of the arrhythmia were strikingly less frequent in patients whose atrial fibrillation lasted 12 months or less (33/103, 32.3%) than in those whose atrial fibrillation lasted more than 12 months (30/38, 78.94%). In the multivariate analysis, the mode of reversion (HR, 0.37; CI, 0.21-0.65) and the duration of the arrhythmia (HR, 2.55; CI, 1.54-4.20) were the determinants for long-term sinus rhythm maintenance. Age, sex, left atrium size, left ventricle diameter, and the shortening fraction did not significantly influence the rate of arrhythmia recurrence. Among the 141 patients included in the study, 113 patients were followed for at least 1 year, and cardiac rhythm was assessed at this time. Of these, only 1 of 48 patients (2.1%) in Group I was in atrial fibrillation, in marked contrast with 18 of 65 patients (27.8%) in Group II (RR, 0.075; 95% CI, 0.01-0.54).

Conclusions: In patients with persistent atrial fibrillation, long-term preservation of sinus rhythm under chronic amiodarone treatment may be anticipated when the arrhythmia lasts 12 months or less and/or its reversion is obtained pharmacologically. We may confidently assume that these two factors have a beneficial additive influence on the outcome.

Key Words: arrhythmia • cardioversion • antiarrhythmic drugs

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 8, No. 3, 179-186 (2003)
DOI: 10.1177/107424840300800302


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