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Intravenous Amiodarone for Arrhythmia Management
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IN RESPONSE:
We thank Drs. Halkin and Shibolet for pointing out our editing error. On line four of the last paragraph in the left column on page 297, references 36 and 43 should have been cited in addition to 34.
With regard to the issue of considering intravenous amiodarone as the first-line agent for cardioversion for a recent onset of atrial fibrillation or flutter, we strongly believe that the choice of agent should be individualized according to the clinical setting. In the setting of left ventricular dysfunction or acute myocardial infarction, we agree that intravenous amiodarone could be considered a first-line agent.
To our knowledge, no study has compared the cost-effectiveness of intravenous amiodarone with that of other antiarrhythmic agents for atrial fibrillation treatment. However, as mentioned in our article, because intravenous amiodarone is more expensive than other agents (for example, procainamide) and often requires central venous line placement as a result of phlebitis, it is possible that intravenous amiodarone may be more costly than other drugs. Because adverse effects from various antiarrhythmic therapies can affect the relative cost, a formal cost-effectiveness analysis of intravenous amiodarone in the various clinical settings, including atrial fibrillation, is needed.
- Copyright ©2004 by the American College of Physicians
