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Intravenous Amiodarone for Arrhythmia Management
- Amir Halkin, MD; and
- Oren Shibolet, MD
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TO THE EDITOR:
In their otherwise excellent review of intravenous amiodarone for arrhythmia management [1], Desai and colleagues misquoted the first reference they cited for the comparison of amiodarone with propafenone in conversion of recent-onset atrial fibrillation (reference 34 in their article, cited on page 297). This trial actually compared prophylactic amiodarone with placebo for the prevention of supraventricular and ventricular tachyarrhythmias in 77 patients recovering from coronary artery bypass surgery [2]. The investigators did not randomly assign patients to either propafenone or flecainide as stated by Desai and colleagues. Amiodarone and propafenone for conversion of atrial fibrillation or flutter to sinus rhythm in the post-operative setting were recently compared in a randomized trial [3]. Although eventual success rates did not differ significantly for both drugs (77% for amiodarone and 67% for propafenone), propafenone resulted in earlier reversion to sinus rhythm. Similar findings have been reported in other clinical settings, but some still consider amiodarone the drug of choice in patients with paroxysmal atrial fibrillation and left ventricular dysfunction or acute myocardial infarction because of its less potent negative inotropic effect [4].
Desai and colleagues provide no data to support their assumption on the relative cost-effectiveness of amiodarone and other drugs used for recent-onset atrial fibrillation. Given this and the significant rate of early adverse cardiac events in patients with atrial fibrillation receiving other antiarrhythmic drugs [5], amiodarone should be considered a first-line agent for cardioversion of selected patients with recent-onset atrial fibrillation or flutter.
Amir Halkin, MD
Oren Shibolet, MD
Hadassah University Hospital; Mt. Scopus, Jerusalem 91240, Israel
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
