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Low-Dose Amiodarone for Atrial Fibrillation: Time for a Prospective Study?

Holly R. Middlekauff, MD; Isaac Wiener, MD; Leslie A. Saxon, MD; and William G. Stevenson, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Holly R. Middlekauff, MD, UCLA Division of Cardiology, 47-123 CHS, 10833 Le Conte Avenue, Los Angeles, CA 90024-1679.

Current Author Addresses: Drs. Middlekauff, Saxon, and Stevenson: UCLA Division of Cardiology, Department of Medicine, UCLA School of Medicine, UCLA, 47-123 CHS, Los Angeles, CA 90024-1679. Dr. Wiener: 100 UCLA Medical Plaza, Suite 770, Los Angeles, CA 90024.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(12_Part_1):1017-1020. doi:10.7326/0003-4819-116-12-1017
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▪ Because atrial fibrillation is associated with substantial morbidity, restoration of sinus rhythm is desirable. Long-term maintenance of sinus rhythm often requires chronic antiarrhythmic therapy. Class I antiarrhythmic drugs such as quinidine or propafenone maintain sinus rhythm in approximately 50% of patients at 1 year and have risks for proarrhythmia and noncardiac toxicity. Studies of low-dose amiodarone for atrial fibrillation have reported sinus rhythm maintenance in 53% to 79% of patients during a mean follow-up of 27 months. Amiodarone has a lower incidence of proarrhythmia and heart failure exacerbation compared with class I drugs. Most noncardiac side effects are dose related, and low-dose amiodarone (< 300 mg/d) is well tolerated. The time has come for a large-scale prospective evaluation of low-dose amiodarone treatment early in the course of atrial fibrillation.





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