Intravenous Amiodarone for the Treatment of Atrial Fibrillation in the Nonsurgical Patient

Abstract

Purpose: To review the literature to define the efficacy of intravenous (IV) amiodarone in the treatment of atrial fibrillation in the nonsurgical patient. Method: A MEDLINE search was conducted using the key words “intravenous amiodarone” and “atrial fibrillation.” All trials evaluating the use of intravenous amiodarone in the surgical setting were excluded. Results: Twenty articles were identified, which were divided into acute and chronic atrial fibrillation. Within the acute setting, IV amiodarone was used alone, compared to a placebo-control, or compared to active drug regimens. In the trials without a control group, it was difficult to determine how much of the effect was due to spontaneous conversion. When compared to placebo, IV amiodarone offered a 61% to 92% conversion at 24 hours. Compared to active drug therapy, there was a trend to increased efficacy at 24 hours. However, amiodarone was no more effective for the conversion of atrial fibrillation than alternative therapies. In the case of chronic atrial fibrillation, intravenous amiodarone had no benefit. The incidence of thrombophlebitis, bradycardia, and hypotension was quite high, reported to be around 15% to 30% in many of the trials. Conclusion: The use of intravenous amiodarone should not be recommended as the first line agent for the conversion of atrial fibrillation.