Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation

被引:67
作者
Khan, IA
Mehta, NJ
Gowda, RM
机构
[1] Creighton Univ, Sch Med, Dept Med, Div Cardiol, Omaha, NE 68131 USA
[2] Long Isl Coll Hosp, Dept Med, Div Cardiol, Brooklyn, NY 11201 USA
关键词
atrial fibrillation; amiodarone; pharmacological cardioversion; chemical cardioversion; class III antiarrhythmic drugs;
D O I
10.1016/S0167-5273(02)00477-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The efficacy and safety of amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation was examined by reviewing the trials on the subject identified through a comprehensive literature search. Amiodarone has been used both intravenously (i.v.) and orally for the pharmacological cardioversion of recent-onset atrial fibrillation. Intravenous amiodarone has been used as a bolus only or as a bolus followed by a continuous i.v. infusion until conversion or up to 24 It. The dose of i.v. bolus given ranged from 3 to 7 mg/kg body weight and that of infusion from 900 to 3000 mg/day. The efficacy reported is 34-69% with the bolus only regimens, and 55-95% with the bolus followed by infusion regimens. Only the higher dose (>1500 mg/day) amiodarone is superior to placebo in converting recent-onset atrial fibrillation to sinus rhythm. The highest 24-h conversion rates have been reported with the i.v. regimen of 125 mg/h until conversion or a maximum of 3 g and the oral regimen of 25-30 mg/kg body weight administered as a single loading-dose (>90% and >85%, respectively). Most of the conversions occur after 6-8 h of the initiation of therapy. Predictors of successful conversion are shorter duration of atrial fibrillation, smaller left atrial size, and higher amiodarone dose. Amiodarone is not superior to the other antiarrhythmic drugs conventionally used for the pharmacological cardioversion of recent-onset atrial fibrillation but is relatively safe in patients with structural heart disease and in those with depressed left ventricle function. Therefore, amiodarone could be used particularly in patients with structural heart disease and in those with left ventricular systolic dysfunction as the use of class IC drugs, propafenone and flecamide, for cardioversion of atrial fibrillation is contraindicated in such patients. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.
引用
收藏
页码:239 / 248
页数:10
相关论文
共 27 条
[12]   ACUTE TREATMENT OF RECENT-ONSET ATRIAL-FIBRILLATION AND FLUTTER WITH A TAILORED DOSING REGIMEN OF INTRAVENOUS AMIODARONE - A RANDOMIZED, DIGOXIN-CONTROLLED STUDY [J].
HOU, ZY ;
CHANG, MS ;
CHEN, CY ;
TU, MS ;
LIN, SL ;
CHIANG, HT ;
WOOSLEY, RL .
EUROPEAN HEART JOURNAL, 1995, 16 (04) :521-528
[13]   A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation [J].
Joseph, AP ;
Ward, MR .
ANNALS OF EMERGENCY MEDICINE, 2000, 36 (01) :1-9
[14]   Oral loading single dose flecainide for pharmacological cardioversion of recent-onset atrial fibrillation [J].
Khan, IA .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2003, 87 (2-3) :121-128
[15]   Transient atrial mechanical dysfunction (stunning) after cardioversion of atrial fibrillation and flutter [J].
Khan, IA .
AMERICAN HEART JOURNAL, 2002, 144 (01) :11-22
[16]   Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation [J].
Khan, IA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 37 (02) :542-547
[17]   Intravenous propafenone versus intravenous amiodarone in the management of atrial fibrillation of recent onset: A placebo-controlled study [J].
Kochiadakis, GE ;
Igoumenidis, NE ;
Simantirakis, EN ;
Marketou, ME ;
Parthenakis, FI ;
Mezilis, NE ;
Vardas, PE .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1998, 21 (11) :2475-2479
[18]   Efficacy and safety of intravenous amiodarone in recent-onset atrial fibrillation: experience in patients admitted to a general internal medicine department [J].
Kreiss, Y ;
Sidi, Y ;
Gur, H .
POSTGRADUATE MEDICAL JOURNAL, 1999, 75 (883) :278-281
[19]   Intravenous amiodarone for therapy of atrial fibrillation and flutter in critically ill patients with severely depressed left ventricular function [J].
Kumar, A .
SOUTHERN MEDICAL JOURNAL, 1996, 89 (08) :779-785
[20]   Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm [J].
Martínez-Marcos, FJ ;
García-Garmendia, JL ;
Ortega-Carpio, A ;
Fernández-Gómez, JM ;
Santos, JM ;
Camacho, C .
AMERICAN JOURNAL OF CARDIOLOGY, 2000, 86 (09) :950-953