title: Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial.
abstract: BACKGROUND
  Amiodarone and sotalol are commonly used for the maintenance of sinus rhythm, but the efficacy of these agents administered as high-dose infusions for rapid conversion of atrial fibrillation is unknown. Use in this context would facilitate drug initiation in patients in whom ongoing prophylactic therapy is indicated.
  
  
  METHODS
  We assessed the efficacy and safety of rapid high-dose intravenous infusions of amiodarone and sotalol for heart rate control and rapid reversion to sinus rhythm in patients who came to the emergency department with recent-onset symptomatic atrial fibrillation. Patients (n = 140) were randomized to receive 1.5mg/kg of sotalol infused in 10 minutes, 10mg/kg of amiodarone in 30 minutes, or 500 microg of digoxin in 20 minutes. Electrical cardioversion was attempted for patients not converting to sinus rhythm within 12 hours.
  
  
  RESULTS
  The rapid infusion of sotalol or amiodarone resulted in more rapid rate control than digoxin. Each of the 3 trial strategies resulted in similar rates of pharmacological conversion to sinus rhythm (amiodarone, 51%; sotalol, 44%; digoxin, 50%; P = not significant). The overall rates of cardioversion after trial drug infusion and defibrillation were high for all groups (amiodarone, 94%; sotalol, 95%,; digoxin, 98%; P = not significant), but there was a trend toward a higher incidence of serious adverse reactions in the amiodarone group.
  
  
  CONCLUSIONS
  The rapid infusion of sotalol or amiodarone in patients with symptomatic recent-onset atrial fibrillation results in rapid control of ventricular rate. Even with high-dose rapid infusions, all 3 agents are associated with a poor overall reversion rate within 12 hours. Almost all patients were returned to sinus rhythm with a combination of pharmacological therapy and electrical cardioversion.
authors.affiliation: Department of Cardiology, Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia. stuartpt@yahoo.com
authors.forename: Stuart P
authors.initials: SP
authors.lastname: Thomas
authors.forename: Duncan
authors.initials: D
authors.lastname: Guy
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wallace
authors.forename: Roselyn
authors.initials: R
authors.lastname: Crampton
authors.forename: Pat
authors.initials: P
authors.lastname: Kijvanit
authors.forename: Vicki
authors.initials: V
authors.lastname: Eipper
authors.forename: David L
authors.initials: DL
authors.lastname: Ross
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004077:Digoxin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D013015:Sotalol / Q000008:administration & dosage*; D018709:Statistics, Nonparametric
chemical_list: D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D013015:Sotalol; D000638:Amiodarone