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Management of Atrial Fibrillation
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Important miscalculations were made in a recently published Markov decision analysis of atrial fibrillation [1]. In their review comparing warfarin with no treatment, the authors considered randomized, placebo-controlled trials that evaluated intention to treat and all-cause mortality. This was only slightly altered regarding quinidine. When evaluating amiodarone, the authors considered open-label, nonrandomized studies and only looked at drug-associated mortality. Second, Disch and colleagues [1] may have underestimated the amiodarone-associated annual mortality rate at 0.09%. One study acknowledged that amiodarone proarrhythmia was underestimated and reported a 25% incidence of pulmonary fibrosis over 5 years, with a higher incidence in those older than 60 years of age [2]. A review of pulmonary fibrosis listed the mortality rate as 23% [3]. If the mortality rate related to pulmonary fibrosis were only 10%, the amiodarone-associated mortality rate would be at least 2% (20 times higher than 0.09%). Third, the Markov decision analysis relied on studies with short-term follow-up periods inadequate to analyze quality of life. Side effects of amiodarone often depend on the dose duration. We reported a few side effects over a 1.8-year follow-up period [4]. Over the next 5 years, however, most of our patients could not tolerate amiodarone and required dose reductions to subtherapeutic levels, resulting in a resumption of atrial fibrillation. Only Herre and colleagues [2] have published a report with a mean 5-year follow-up that evaluated long-term side effects. Herre [5] later cautioned about the side-effect profile of amiodarone for atrial fibrillation. Disch and colleagues also failed to compare the financial cost of amiodarone with that of other therapies. Amiodarone and its necessary follow-up laboratory testing are more expensive than the alternative therapies. We agree that amiodarone should be considered for the treatment of atrial fibrillation, but only in high-risk or refractory patients.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
