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Episodic Amiodarone Treatment Appears to Worsen Outcomes in Patients With Atrial Fibrillation CHICAGO -- October 14, 2008 -- Reducing how often a patient receives amiodarone does not decrease the overall amount of amiodarone-related and heart disease related side effects, but did increase the rate of atrial fibrillation recurrence and the risk of death from all causes and cardiovascular hospitalisations, according to a study in the October 15 issue of JAMA. Sheba Ahmed, MD, University of Groningen, Groningen, the Netherlands, and colleagues conducted a study to compare the effects of episodic versus continuous amiodarone treatment on major events related to amiodarone use and to determine if episodic treatment could effectively suppress atrial fibrillation. The trial included 209 patients with recurrent atrial fibrillation who were randomly assigned to receive either episodic or continuous amiodarone treatment. Episodic amiodarone treatment was discontinued after a month of sinus rhythm and reinitiated if atrial fibrillation relapsed. In the continuous treatment group amiodarone was maintained throughout. After a median follow-up of 2.1 years, 51 (48%) of the patients in the episodic versus 64 (62%) in the continuous treatment group had sinus rhythm. The researchers found that in the episodic group, more atrial fibrillation recurrences occurred (80%) than in the continuous treatment group (54%). The incidence of the primary outcome for the study -- any amiodarone or underlying heart disease-related major event -- was 35% in the episodic versus 33% in the continuous treatment group. There were differences in the incidence of amiodarone major events in the episodic group (19%) compared with the continuous treatment group (24%), as well as underlying heart disease-related major events (16% vs. 9%), although these differences did not reach statistical significance. All-cause deaths and cardiovascular hospitalisations were higher among those receiving episodic treatment (53% vs. 34%). "Considering the above, episodic amiodarone treatment cannot be advocated for most patients with persistent atrial fibrillation," the authors wrote. "This study shows that episodic amiodarone treatment, in contrast to our expectations, has no clinical advantage over continuous treatment because it did not lower morbidity in patients with persistent atrial fibrillation over 2 years of follow-up." SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version