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Efficacy of Amiodarone for the Termination of Chronic Atrial Fibrillation and Maintenance of Normal Sinus Rhythm: A Prospective, Multicenter, Randomized, Controlled, Double Blind Trial

GEFACA Investigators-GEMA GROUP, Buenos Aires, Argentina; Hospital Durand, Buenos Aires, Argentina

Marcelo V. Elizari, MD, FACC

Pablo A. Chiale, MD

Remberto Torres Molina, MD

GEFACA Investigators-GEMA GROUP, Buenos Aires, Argentina; Hospital Ramos Mejia, Buenos Aires, Argentina

Rauil Ledesma, MD

GEFACA Investigators-GEMA GROUP, Buenos Aires, Argentina; Instituto del Corazon, Cordoba, Argentina

Angel O. Scapin, MD

GEFACA Investigators-GEMA GROUP, Buenos Aires, Argentina; G.E.M.A. Grupo de Estudios Multicentricos Argentinos, Argentina

Manuel Vaizquez Blanco, MD, FACC

GEFACA Investigators-GEMA GROUP, Buenos Aires, Argentina; Hospital de Clinicas, Buenos Aires, Argentina

Objective: We sought to assess the efficacy and safety of amiodarone for restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation in a prospective, randomized, double blind trial.

Background: Restoration and preservation of sinus rhythm is difficult in patients with chronic atrial fibrillation. The efficacy of oral amiodarone has not been conclusively established.

Methods: Ninety-five patients with chronic atrial fibrillation, lasting an average of 35.6 months, were randomized to either amiodarone (600 mg/d) (47 patients) or placebo (48 patients) during four weeks. Nonresponders underwent electric cardioversion, and those who reverted continued with amiodarone (200 mg/d) or placebo. End-points were successful cardioversion and sinus rhythm maintenance.

Results: Sixteen patients (34.04%) in the amiodarone group reverted within 27.28 ± 8.85 days in comparison with 0% in the placebo group (P < 0.000009). The conversion rate rose to 51.72% in patients with chronic atrial fibrillation lasting less than 12 months. Twenty-eight patients in the amiodarone group and 39 in the placebo group underwent electric cardioversion, which was successful in 19 patients (67.8%) of the amiodarone group and in 15 (38.46%) of the placebo group (P = 0.017). Altogether, conversion was obtained in 79.54% of the amiodarone group patients and in 38.46% of the placebo group patients (P < 0.0001). During follow-up, atrial fibrillation relapsed in 13 (37.14%) of 35 patients of the amiodarone group within 8.84 + 8.57 months and in 12 (80%; P = 0.009) of 15 patients of the placebo group within 2.74 ± 3.41 months.

Conclusions: Oral amiodarone restored sinus rhythm in one third of patients with chronic atrial fibrillation, increased the success rate of electric cardioversion, decreased the number of relapses and delayed their occurrence.

Key Words: arrhythmia • cardioversion • antiarrhythmic drugs

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 6, No. 4, 341-350 (2001)
DOI: 10.1177/107424840100600403


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