Episodic Amiodarone Shows No Advantage over Continuous Treatment for Afib

In patients with atrial fibrillation, episodic amiodarone offers no advantage over continuous treatment and may even increase adverse events, according to a JAMA study.

Some 200 adults with persistent, symptomatic afib underwent electrical cardioversion (after amiodarone loading) and then were randomized to receive episodic or continuous amiodarone. During a median 2 years' follow-up, the incidence of the primary composite endpoint — adverse events related to amiodarone (e.g., thyroid dysfunction) or underlying heart disease (e.g., heart failure) — did not differ between the groups.

However, secondary endpoints (cardiovascular hospitalization or all-cause mortality) occurred more often with episodic than with continuous therapy (53% vs. 34%).

In Journal Watch Cardiology, Mark Link notes that episodic treatment was also associated with more afib recurrences and cardioversion interventions. He concludes: "For now, clinicians who choose amiodarone treatment [for afib] should prescribe continuous therapy at the lowest dose possible (generally, about 200 mg/day)."