Atrial fibrillation recurrence higher with episodic treatment with amiodarone

General

Clinical Question:
Is continuous or episodic prophylactic treatment with amidarone safer and more effective for the prevention of atrial fibrillation in adults?

Bottom Line:
Atrial fibrillation is less likely to recur in adults receiving continuous rather than episodic amiodarone treatment. There were no differences in major adverse events between treatment groups. (LOE = 1b-)

Reference:
Ahmed S, Rienstra M, Crijns HJ, et al, for the CONVERT Investigators. Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation. A randomized trial. JAMA 2008;300(15):1784-1792.  [PMID:18854540]

Study Design:
Randomized controlled trial (double-blinded)

Allocation:
Uncertain

Setting:
Outpatient (specialty)

Synopsis:
Amiodarone is effective at preventing recurrence of atrial fibrillation but it also frequently results in noncardiac adverse events. These investigators identified 214 adults with a mean age 67 years and recurrence of symptomatic persistent atrial fibrillation or atrial flutter of less than 1 year's duration. After anticoagulation and a 4-week loading period of amiodarone (600 mg daily), all patients not otherwise in sinus rhythm underwent electrical cardioversion. After cardioversion, amiodarone was lowered to a dose of 200 mg daily. Patients then randomly received continued amiodarone (continuous treatment) or had their amiodarone treatment discontinued 4 weeks after randomization and only restarted with recurrence of atrial fibrillation (episodic treatment). Individuals assessing all outcomes remained masked to treatment group assignment. Follow-up occurred for 98% of patients for a mean of 2.1 years. Using intention-to-treat analysis, atrial fibrillation requiring treatment recurred significantly less often in the continuous group than in the episodic treatment group (54% vs 80%; number needed to treat = 4; 95% CI, 3-6). There was also a significantly increased rate of the composite outcome of all-cause mortality and cardiovascular hospitalizations with episodic treatment compared with continuous treatment (53% vs 34%).

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