Amiodarone versus sotalol for atrial fibrillation.
BACKGROUND
The optimal pharmacologic means to restore and maintain sinus rhythm in patients with atrial fibrillation remains controversial.


METHODS
In this double-blind, placebo-controlled trial, we randomly assigned 665 patients who were receiving anticoagulants and had persistent atrial fibrillation to receive amiodarone (267 patients), sotalol (261 patients), or placebo (137 patients) and monitored them for 1 to 4.5 years. The primary end point was the time to recurrence of atrial fibrillation beginning on day 28, determined by means of weekly transtelephonic monitoring.


RESULTS
Spontaneous conversion occurred in 27.1 percent of the amiodarone group, 24.2 percent of the sotalol group, and 0.8 percent of the placebo group, and direct-current cardioversion failed in 27.7 percent, 26.5 percent, and 32.1 percent, respectively. The median times to a recurrence of atrial fibrillation were 487 days in the amiodarone group, 74 days in the sotalol group, and 6 days in the placebo group according to intention to treat and 809, 209, and 13 days, respectively, according to treatment received. Amiodarone was superior to sotalol (P<0.001) and to placebo (P<0.001), and sotalol was superior to placebo (P<0.001). In patients with ischemic heart disease, the median time to a recurrence of atrial fibrillation was 569 days with amiodarone therapy and 428 days with sotalol therapy (P=0.53). Restoration and maintenance of sinus rhythm significantly improved the quality of life and exercise capacity. There were no significant differences in major adverse events among the three groups.


CONCLUSIONS
Amiodarone and sotalol are equally efficacious in converting atrial fibrillation to sinus rhythm. Amiodarone is superior for maintaining sinus rhythm, but both drugs have similar efficacy in patients with ischemic heart disease. Sustained sinus rhythm is associated with an improved quality of life and improved exercise performance.
Singh
Bramah N
BN
Department of Veterans Affairs Medical Center, West Los Angeles, Calif 90073, USA. bsingh@ucla.edu
Singh
Steven N
SN
Reda
Domenic J
DJ
Tang
X Charlene
XC
Lopez
Becky
B
Harris
Crystal L
CL
Fletcher
Ross D
RD
Sharma
Satish C
SC
Atwood
J Edwin
JE
Jacobson
Alan K
AK
Lewis
H Daniel
HD
Raisch
Dennis W
DW
Ezekowitz
Michael D
MD
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D018572:Disease-Free Survival; D004311:Double-Blind Method; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications; D011788:Quality of Life; D055502:Secondary Prevention; D013015:Sotalol / Q000009:adverse effects / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D000638:Amiodarone