Amiodarone for maintaining sinus rhythm after cardioversion of atrial fibrillation

Evidence Summaries

Level of Evidence = A
Amiodarone is more effective than placebo in reducing atrial fibrillation recurrence after cardioversion.

A Cochrane review 1 on antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation included 59 studies with a total of 20,981 subjects. Amiodarone was included in 13 of the studies (n=2,630), and 6 of them compared amiodarone with placebo or no treatment.

Compared to placebo/no treatment amiodarone reduced atrial fibrillation recurrence (RR 0.52, 95% CI 0.46 to 0.58; 6 studies, n=812). This corresponded to a recurrence rate of 81.2% in people not receiving active treatment and 42.2% (95% CI 37.3% to 47.1%) in people receiving amiodarone. The NNTB for amiodarone was 3 (95% CI 2 to 4) participants treated for one year to avoid one recurrence. In direct comparisons between antiarrhythmics, amiodarone appeared to reduce recurrence of atrial fibrillation more than combined class I drugs, more than dronedarone, and more than sotalol.

There was no statistically dignificant increase in proarrhythmia with amiodarone compared to placebo or no treatment (RR 2.22, 95% CI 0.71 to 6.96; 4 studies, n=673). In direct comparisons between antiarrhythmics, amiodarone seemed to produce fewer proarrhythmic events than class I drugs combined, but showed no clear differences compared with dronedarone or sotalol.

Amiodarone seemed to produce fewer withdrawals than class I drugs combined, but showed no difference compared with dronedarone or sotalol. However, compared to placebo or no treatment, amiodarone had a high RR for increasing withdrawals due to an adverse event (RR 6.70, 95% CI 1.91 to 23.45; 4 studies, n=319) The NNTH for amiodarone was 25 (95% CI 6 to 157) subjects treated for one year to have one additional withdrawal. When compared with placebo or no treatment, amiodarone showed no significant difference in mortality (RR 1.66, 95% CI 0.55 to 4.99; 2 studies, n=444).

References

1. Valembois L, Audureau E, Takeda A et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2019;(9):CD005049.  [PMID:31483500].


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Amiodarone for maintaining sinus rhythm after cardioversion of atrial fibrillation is a sample topic from the Evidence-Based Medicine Guidelines.

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