Recent-onset atrial fibrillation, d...

Recent-onset atrial fibrillation, defined as an attack within one week, is a major issue in clinical practice, and late advances have shown that cardioversion to normal sinus periodical emphasis provides better patient outcomes. Cardioversion can be attempted with electric and pharmacologic classifications Immediate electric cardioversion is indicated in patients with recent-onset atrial fibrillation with a rapid ventricular reply who have evidence of acute myocardial ischemia, symptomatic hypotension, angina, or heart failure that does not reply to pharmacologic interventions. In all other cases, pharmacologic cardioversion can be attempted. Medications available for cardioversion include the class I and III antiarrhythmic put drugs intos Class Ic medications such as propafenone and flecainide have been shown to be effective therapeutic options. Amiodarone, a class III agent, also has been shown to be effective in treating this cardiac disease; however, it is not approved by dint of the U.S. Food and physic Administration for treating this arrhythmia. To evaluate amiodarone, Chevalier and colleagues compared the safety and efficacy of this medication in the treatment of recent-onset atrial fibrillation.

The close attention design was a meta-analysis of randomized trials forward the treatment of recent-onset atrial fibrillation comparing amiodarone with placebo and the class Ic physics The database search included MEDLINE, EMBASE, and the Cochrane Controll Trials Register. The trial had to be a prospective, randomized trial of amiodarone versus placebo or a class Ic antiarrhythmic medication. The main consequence measure was rate of cardioversion within 24 hours. Other data mustered included rates of cardioversion at single to two, three to five, and six to eight hours. Mortality and adverse adventures also were analyzed.

There were six studies that compared amiodarone to placebo, and seven studies compared it to the class Ic antiarrhythmics, for a total of 1174 patients. The flows showed that there was no difference between amiodarone and placebo with regard to cardioversion rates at united to two hours, but there was a significant improvement in cardioversion rates with amiodarone after six to eight hours. The class Ic medications had a significantly better rate of cardioversion than amiodarone for up to eight hours, moreover there was no difference between the sum of two units groups at 24 hours. The adverse issues were minimal in all of the studies, with no deaths reported in any of the treatment groups

The authors decide that amiodarone is as safe and effective as the class Ic antiarrhythmic medications at 24 hours in cardioversion of recent-onset atrial fibrillation. It provides an alternative for patients who are not candidates for the more rapid-acting antiarrhythmic medication, of that kind as those with ventricular dysfunction and ischemic heart disease, in whom rapid cardioversion is not required. They also state that these data were based in succession intravenous amiodarone and further studies ne to be done using the oral preparation, to establish the optimal dose, and to determine when to start outpatient treatment.

Chevalier P et al. Amiodarone versus placebo and class Ic physics for cardioversion of recent-onset atrial fibrillation: a meta-analysis. J Am Coll Cardiol January 15 2003;41: 255-62

COPYRIGHT 2003 American Academy of Family Physicians

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