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Intravenous amiodarone for acute pharmacological conversion of atrial fibrillation in the emergency department

Published online by Cambridge University Press:  21 May 2015

Richard S. Slavik
Richard S. Slavik*
Affiliation:
Clinical Services Unit — Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, Vancouver, BC; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
*
Clinical Services Unit — Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, 855 West 12th Ave., Vancouver BC V5Z 1M9; 604 875-4077, fax 604 875-5267, rslavik@interchange.ubc.ca

Abstract

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Atrial fibrillation (AF) is the most common arrhythmia seen in patients presenting to the emergency department (ED). Pharmacological conversion of atrial fibrillation to normal sinus rhythm (NSR) may be a feasible management strategy in selected patients. Recent guidelines have recommended intravenous amiodarone, a class III antiarrhythmic agent, for the conversion of AF to NSR. The purpose of this review is to examine the published evidence for the efficacy of IV amiodarone for the acute conversion of AF to NSR in the ED. Currently available data from 11 randomized, controlled trials and 3 meta analyses do not support the use of conventional doses of IV amiodarone for acute conversion in the ED. High dose IV or combined IV and oral administration may be effective as early as 8 hours in patients with recent-onset AF of ≤48 hour duration in patients without contraindications to these high dose regimens. There are no data to support the use of IV amiodarone for acute conversion in patients with an ejection fraction of <40% or clinical heart failure, so its use in these scenarios should be limited to symptomatic patients who are refractory to electrical conversion. More well-designed studies are required to determine the role of IV amiodarone for the acute conversion of AF in the ED.

Keywords

amiodaroneatrial fibrillationconversionantiarrhythmic agents
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 6 , November 2002 , pp. 414 - 420
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Kannel, WB, Wolf, PA, Benjamin, EJ, Levy, D.Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates. Am J Cardiol 1998;82(8A): 2N–9N.Google Scholar
2.Chugh, SS, Blackshear, JL, Shen, WK, Hammill, SC, Gersh, BJ.Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 2001;37:371–8.Google Scholar
3.Go, AS, Hylek, EM, Phillips, KA, Chang, Y, Henault, LE, Selby, JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285(18):2370–5.CrossRefGoogle ScholarPubMed
4.Feinberg, WM, Blackshear, JL, Laupacis, A, Kronmal, R, Hart, RG.Prevalence, age distribution and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 1995;155:469–73.CrossRefGoogle ScholarPubMed
5.Kannel, WB, Abbott, RD, Savage, DD, McNamara, PM.Epidemiologic features of chronic atrial fibrillation: the Framingham Study. N Engl J Med 1982;306:1018–22.Google Scholar
6.Bialy, D, Lehmann, MH, Schumacher, DN.Hospitalization for arrhythmias in the United States: importance of atrial fibrillation [abstract]. J Am Coll Cardiol 1992;19:41A.Google Scholar
7.Connors, S, Dorian, P.Management of supraventricular tachycardia in the emergency department. Can J Cardiol 1997;13:19A–24A.Google ScholarPubMed
8.Dell’Orfano, JT, Patel, H, Wolbrette, DL, Luck, JC, Naccarelli, GV.Acute treatment of atrial fibrillation: spontaneous conversion rates and cost of care. Am J Cardiol 1999;83:788–90.Google Scholar
9.Kim, MH, Conlon, B, Ebinger, M, Bruckman, D, Kronick, S, Lowell, M, et al. Clinical outcomes and costs associated with a first episode of uncomplicated atrial fibrillation presenting to the emergency room. Am J Cardiol 2001;88(1):A7, 74–6.Google Scholar
10.Prystowsky, EN, Benson, DW, Fuster, V, Hart, RG, Kay, GN, Myerburg, RJ, et al. Management of patients with atrial fibrillation. A Statement for Healthcare Professionals. From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation 1996;93(6):1262–77.Google Scholar
11.Lok, NS, Lau, CP.Presentation and management of patients admitted with atrial fibrillation: a review of 291 cases in a regional hospital. Int J Cardiol 1995;48:271–8.Google Scholar
12.Wolf, PA, Mitchell, JB, Baker, CS, Kannel, WB, D’Agostino, RB.Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998;158:229–34.Google Scholar
13.Michaels, JA, Stiell, IG, Agarwal, S, Mandavia, DP.Cardioversion of paroxysmal atrial fibrillation in the emergency department. Ann Emerg Med 1999;33:379–87.Google Scholar
14.Levy, S, Breithardt, G, Campbell, RWF, Camm, AJ, Daubert, JC, Allessie, M, et al. Atrial fibrillation: current knowledge and recommendations for management. Eur Heart J 1998;19:1294–320.Google Scholar
15.Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The American Heart Association in collaboration with the International Liason Committee on Resuscitation. Circulation 2000;102(8 suppl):I1–I384.Google Scholar
16.Fuster, V, Ryden, LE, Asinger, RW, Cannom, DS, Crijns, HJ, Frye, RL, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. J Am Coll Cardiol 2001;38:1231–65.CrossRefGoogle ScholarPubMed
17.Albers, GW, Dalen, JE, Laupacis, A, Manning, WJ, Petersen, P, November • novembre 2002; 4 (6) Singer, DE.Antithrombotic therapy in atrial fibrillation. CHEST 2001;119:194S–204S.Google Scholar
18.Falk, R.Atrial fibrillation. N Engl J Med 2001;344:1067–78.Google Scholar
19.Kudenchuk, PJ, Cobb, LA, Copass, MK, Cummins, RO, Doherty, AM, Fahrenbruch, CA, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999;341:871–8.Google Scholar
20.Dorian, P, Cass, D, Schwartz, B, Cooper, R, Gelaznikis, R, Barr, A.Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002;346:884–90.Google Scholar
21.Kowey, PR, Marinchak, RA, Rials, SJ, Filart, RA.Acute treatment of atrial fibrillation. Am J Cardiol 1998;81:16C–22C.Google Scholar
22.Costeas, C, Kassotis, J, Blitzer, M, Reiffel, JA.Rhythm management in atrial fibrillation — with a primary emphasis on pharmacological therapy: Part 2. Pacing Clin Electrophysiol 1998;21 (4 pt 1):742–52.Google Scholar
23.Connolly, SJ.Evidence-based analysis of amiodarone efficacy and safety. Circulation 1999;100:2025–34.Google Scholar
24.Falk, RH, Knowlton, AA, Bernard, SA, Gotlieb, NE, Battinelli, NJ.Digoxin for converting recent-onset atrial fibrillation to sinus rhythm. A randomized, double-blinded trial. Ann Intern Med 1987;106:503–6.Google Scholar
25.Slavik, RS, Tisdale, JE, Borzak, S.Pharmacologic conversion of atrial fibrillation: a systematic review of available evidence. Prog Cardiovasc Dis 2001;44:121–52.Google Scholar
26.Nolan, JP, de Latorre, FJ, Steen, PA, Chamberlain, DA, Bossaert, LL.Advanced life support drugs: Do they really work? Curr Opin Crit Care 2002;8:212–8.CrossRefGoogle ScholarPubMed
27.Chow, MSS.Intravenous amiodarone: pharmacology, pharmacokinetics, and clinical use. Ann Pharmacother 1996;30:637–43.Google Scholar
28.Wellens, HJJ, Brugada, P, Abdollah, H, Dassen, WR.A comparison of the electrophysiologic effects of intravenous and oral amiodarone in the same patient. Circulation 1984;69:120–4.CrossRefGoogle ScholarPubMed
29.Zhou, L, Chow, MSS, Chen, BP, Fan, C, Kluger, J.Electrophysiologic and antifibrillatory effects of amiodarone and desethylamiodarone. J Am Coll Cardiol 1997;29:34A.Google Scholar
30.Schwartz, A, Shen, E, Morady, F, Gillespie, K, Scheinman, M, Chatterjee, K.Hemodynamic effects of intravenous amiodarone in patients with depressed left ventricular function and recurrent ventricular tachycardia. Am Heart J 1983;106:848–54.CrossRefGoogle ScholarPubMed
31.Kosinski, EJ, Albin, JB, Young, E, Lewis, SM, LeLand, OS.Hemodynamic effects of intravenous amiodarone. J Am Coll Cardiol 1984;4:565–70.Google Scholar
32.Carrel, T, Meyer, B, Candinas, R, Turina, M, Schmid, ER.Intravenous amoiodarone versus propafenone for atrial fibrillation and flutter after cardiac surgery: a note of caution. Eur J Cardiothorac Surg 1996;10:1144–6.Google Scholar
33.Noc, M, Stajer, D, Horvat, M.Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm. Am J Cardiol 1990;65:679–80.CrossRefGoogle ScholarPubMed
34.Cowan, JC, Gardiner, P, Reid, DS, Newell, DJ, Campbell, RW.A comparison of amiodarone and digoxin in the treatment of atrial fibrillation complicating suspected myocardial infarction. J Cardiovasc Pharmacol 1986;8:252–6.Google Scholar
35.Donovan, KD, Power, BM, Hockings, BE, Dobb, GJ, Lee, KY.Intravenous flecainide versus amiodarone for recent-onset atrial fibrillation. Am J Cardiol 1995;75:693–7.Google Scholar
36.Galve, E, Rius, T, Ballester, R, Artaza, MA, Arnau, JM, Garcia-Dorado, D, et al. Intravenous amiodarone in treatment of recent-onset atrial fibrillation: Results of a randomized, controlled study. J Am Coll Cardiol 1996;27:1079–82.CrossRefGoogle ScholarPubMed
37.Joseph, AP, Ward, MR.A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for reversion of new-onset atrial fibrillation. Ann Emerg Med 2000;36:1–9.Google Scholar
38.Capucci, A, Lenzi, T, Boriani, G, Trisolino, G, Binetti, N, Cavazza, M, et al. Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with systemic hypertension. Am J Cardiol 1992;70:69–72.Google Scholar
39.Hou, ZY, Chang, MS, Chen, CY, Lin, SL, Chiang, HT, Woosley, RL.Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone: A randomized, digoxin-controlled study. Eur Heart J 1995;16:521–8.Google Scholar
40.Boriani, G, Biffi, M, Capucci, A, Botto, G, Broffoni, T, Ongari, M, et al. Conversion of recent-onset atrial fibrillation to sinus rhythm: Effects of different drug protocols. Pacing Clin Electrophysiol 1998;21:2470–4.Google Scholar
41.Cotter, G, Blatt, A, Kaluski, E, Metzkor-Cotter, E, Koren, M, Litinski, I, et al. Conversion of recent-onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone — A randomized, placebo-controlled study. Eur Heart J 1999;20:1833–42.Google Scholar
42.Kochiadakis, GE, Igoumenidis, NE, Simantirakis, EN, Marketou, ME, Parthenakis, FI, Mezilis, NE, et al. Intravenous propafenone versus intravenous amiodarone in the management of atrial fibrillation of recent-onset: A placebo-controlled study. Pacing Clin Electrophysiol 1998;21(pt II):2475–9.Google Scholar
43.Vardas, PE, Kochiadakis, GE, Igoumendis, NE, Tsatsakis, M, Simantirakis, EN, Chlouverakis, GI.Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation. Chest 2000;117:1538–45.Google Scholar
44.Miller, MR, McNamara, RL, Segal, JB, Kim, N, Robinson, KA, Goodman, SN, et al. Efficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm: a meta-analysis of clinical trials. J Fam Pract 2000;49: 1033–46.Google ScholarPubMed
45.Hilleman, DE, Spinler, SA.Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta analysis of randomized controlled trials. Pharmacotherapy 2002;22:66–74.Google Scholar
46.Nichol, G, McAlister, F, Pham, B, Laupacis, A, Shea, B, Green, M, et al. Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 2002;87(6):535–43.Google Scholar
47.Crijns, HJGM, Van Den Berg, MP, Van Gelder, IC, Van Veldhuisen, DJ.Management of atrial fibrillation in the setting of heart failure. Eur Heart J 1997;18:C45–9.Google Scholar
48.Khand, AU, Rankin, AC, Kaye, GC, Cleland, JGF.Systematic review of the management of atrial fibrillation in patients with heart failure. Eur Heart J 2000;21:614–32.Google ScholarPubMed
49.Danias, PG, Caulfeild, TA, Weigner, MJ, Silerman, DJ, Manning, WJ.Likelihood of spontaneous conversion of atrial fibrillation to NSR. J Am Coll Cardiol 1998;31:588–92.Google Scholar
50.Khan, IA.Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. J Am Coll Cardiol 2001;37:542–7.Google Scholar
51.Reimold, SC, Maisel, WH, Antman, EM.Propafenone for the treatment of supraventricular tachycardia and atrial fibrillation: a meta analysis. Am J Cardiol 1998;82:66N–71N.Google Scholar
52.Kochiadakis, GE, Igoumenidis, NE, Solomou, MC, Parthenakis, FI, Christakis-Hampsas, MG, Chlouverakis, GI, et al. Conversion of atrial fibrillation to sinus rhythm using acute intravenous procainamide infusion. Cardiovasc Drugs Ther 1998;12(1):75–81.CrossRefGoogle ScholarPubMed