title: A comparison of amiodarone and digoxin for treatment of supraventricular arrhythmias after cardiac surgery. Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study. Efficacy of Amiodarone for the Termination of Chronic Atrial Fibrillation and Maintenance of Normal Sinus Rhythm: A Prospective, Multicenter, Randomized, Controlled, Double Blind Trial Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study. Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. A randomized, digoxin-controlled study. Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone. A randomized, placebo-controlled study. Intravenous Amiodarone Decreases the Duration of Atrial Fibrillation Associated with Acute Myocardial Infarction Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo. Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation. Intravenous flecainide versus amiodarone for recent-onset atrial fibrillation. A Comparison of Amiodarone and Digoxin in the Treatment of Atrial Fibrillation Complicating Suspected Acute Myocardial Infarction A comparison of rate control and rhythm control in patients with atrial fibrillation. Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension. Effects of diltiazem pretreatment on direct-current cardioversion in patients with persistent atrial fibrillation: a single-blind, randomized, controlled study. Intravenous digoxin in acute atrial fibrillation. Results of a randomized, placebo-controlled multicentre trial in 239 patients. The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group.
abstract: Despite the widespread use of amiodarone in non-surgical patients , its role in the management of supraventricular tachyarrhythmias after cardiac surgery is not clear . We set out to compare the relative efficacy of amiodarone and digoxin in the management of  atrial fibrillation and flutter in the early postoperative period . This prospect i ve r and omised trial comprised 30 patients , previously in sinus rhythm , who developed sustained atrial fibrillation or flutter following myocardial revascularisation , valve surgery or combined procedures .  Amiodarone was administered as an intravenous loading dose followed by a continuous infusion . Digoxin was given as an intravenous loading dose followed by oral maintenance therapy . Electrocardiographic and haemodynamic monitoring  was continued for 24 h after the commencement of treatment . There was a marked reduction in heart rate in both groups , mainly in the first 6 h , from 146 to 89 beats per minute in the amiodarone group and from 144 to 95 in the digoxin group . At the end of the 24 h , one of the 15 patients in the amiodarone group and 3 of the 15 patients in the digoxin group remained in atrial fibrillation . No patient in either group developed adverse reactions . We conclude that intravenous amiodarone therapy is safe and at least as effective as digoxin in the initial management of arrhythmias after cardiac surgery OBJECTIVE To assess and compare the safety and efficacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation . DESIGN Prospect i ve , r and omised , single blind , placebo controlled study . SETTING Tertiary cardiac referral centre . PATIENTS 186 consecutive patients ( 97 men , 89 women ; mean ( SD ) age , 63 ( 10 ) years ) with recurrent , symptomatic atrial fibrillation . INTERVENTIONS 65 patients were r and omised to amiodarone , 61 to sotalol , and 60 to placebo . Patients receiving amiodarone were maintained at a dose of 200 mg/day after a 30 day loading phase . The sotalol dose was 160 - 480 mg daily , as tolerated . MAIN OUTCOME MEASURES Recurrence of atrial fibrillation or side effects . RESULTS In the amiodarone group , 31 of the 65 patients developed atrial fibrillation after an average of six months , while 15 ( 11 in sinus rhythm and four in atrial fibrillation ) experienced significant side effects after an average of 16 months . In the sotalol group , relapse to atrial fibrillation occurred in 47 of the 61 patients after an average of eight months ; three experienced side effects during the titration phase . In the placebo group , 53 of the 60 patients developed atrial fibrillation after an average of four months ( p < 0.001 for amiodarone and sotalol v placebo ; p < 0.001 for amiodarone v sotalol ) . CONCLUSIONS Both amiodarone and sotalol can be used for the maintenance of normal sinus rhythm in patients with symptomatic atrial fibrillation .  Amiodarone is more effective but causes more side effects Objective : We sought to assess the efficacy and safety of amiodarone for restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation in a prospect i ve , r and omized , double blind trial . Background : Restoration and preservation of sinus rhythm is difficult in patients with chronic atrial fibrillation . The efficacy of oral amiodarone has not been conclusively established . Methods : Ninety-five patients with chronic atrial fibrillation , lasting an average of 35.6 months , were r and omized to either amiodarone ( 600 mg/d ) ( 47 patients ) or placebo ( 48 patients ) during four weeks . Nonresponders underwent electric cardioversion , and those who reverted continued with amiodarone ( 200 mg/d ) or placebo . End-points were successful cardioversion and sinus rhythm maintenance . Results : Sixteen patients ( 34.04 % ) in the amiodarone group reverted within 27.28 ± 8.85 days in comparison with 0 % in the placebo group ( P < 0.000009 ) . The conversion rate rose to 51.72 % in patients with chronic atrial fibrillation lasting less than 12 months . Twenty-eight patients in the amiodarone group and 39 in the placebo group underwent electric cardioversion , which was successful in 19 patients ( 67.8 % ) of the amiodarone group and in 15 ( 38.46 % ) of the placebo group ( P = 0.017 ) . Altogether , conversion was obtained in 79.54 % of the amiodarone group patients and in 38.46 % of the placebo group patients ( P < 0.0001 ) . During follow-up , atrial fibrillation relapsed in 13 ( 37.14 % ) of 35 patients of the amiodarone group within 8.84 + 8.57 months and in 12 ( 80 % ; P = 0.009 ) of 15 patients of the placebo group within 2.74 ± 3.41 months . Conclusions : Oral amiodarone  restored sinus rhythm in one third of patients with chronic atrial fibrillation , increased the success rate of electric cardioversion , decreased the number of relapses and delayed their occurrence AIMS This study compared the efficacy and safety of intravenous dofetilide with amiodarone and placebo in converting atrial fibrillation or flutter to sinus rhythm . METHODS AND RESULTS One hundred and fifty patients with atrial fibrillation or flutter ( duration range 2 h-6 months ) were given 15-min intravenous infusions of 8 microg . kg(-1)of dofetilide ( n=48 ) , 5 mg . kg(-1)of amiodarone ( n=50 ) , or placebo ( n=52 ) and monitored continuously for 3 h. Sinus rhythm was restored in 35 % , 4 % , and 4 % of patients , respectively ( P<0.001 , dofetilide vs placebo;P = ns , amiodarone versus placebo ) . Dofetilide was more effective in atrial flutter than in atrial fibrillation ( cardioversion rates 75 % and 22 % , respectively;P=0.004 ) . The mean time to conversion with dofetilide was 55+/-15 min . Dofetilide prolonged the QTc interval ( + 16 % at 20 min ) . Amiodarone substantially decreased the ventricular rate in non-converters ( -18 beats . min(-1)at 30 min ) . Two patients given dofetilide ( 4 % ) had non-sustained ventricular tachycardias , and four ( 8 % ) had torsade de pointes , in one case requiring electrical cardioversion . CONCLUSION Intravenous dofetilide is significantly more effective than amiodarone or placebo in restoring sinus rhythm in patients with atrial fibrillation or flutter . However , when infused intravenously at this dose and rate , dofetilide causes a significant incidence of torsade de pointes A 24 h intravenous dosing regimen of amiodarone was design ed to reach a peak plasma concentration at 1 h and to maintain the concentration above a certain level during the infusion period . A r and omized , open-label , digoxin-controlled study was undertaken to observe the efficacy and safety of the dosing regimen of amiodarone in treating recent-onset , persistent , atrial fibrillation and flutter with ventricular rates above 130 beats.min-1 . Fifty patients with a mean age of 70 + /- 7 ( SD ) years were enrolled and r and omly assigned to receive either amiodarone intravenously ( n = 26 ) or digoxin ( n = 24 ) . Amiodarone HCl was infused over 24 h according to the following regimen : 5 mg.min-1 , 3 mg.min-1 , 1 mg.min-1 and 0.5 mg.min-1 for 1 , 3 , 6 and 14 h , respectively , for a 70-kg subject . Digoxin ( 0.013 mg.kg-1 ) was infused in three divided doses , each dose 2 h apart and infused over 30 min . The mean heart rates in the amiodarone group decreased significantly from 157 + /- 20 beats.min-1 to 122 + /- 25 beats.min-1 after 1 h ( P < 0.05 vs baseline ) , and then decreased further to stabilize at 96 + /- 25 beats.min-1 after 6 h ( P < 0.05 ) . The digoxin group had fewer dramatic alterations in heart rates , compared to the amiodarone group , in the first 8 h ( P < 0.05 , respectively ) . Maximum reduction was reached only after 8 h. The amiodarone infusion was prematurely aborted in two patients due to severe bradycardia and death after conversion in one patient and aggravation of heart failure in the other . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Spontaneous conversion of recent onset paroxysmal atrial fibrillation  to  normal sinus rhythm  occurs commonly and is not affected by low-dose amiodarone treatment . METHODS In a r and omized , placebo-controlled trial of 100 patients with paroxysmal atrial fibrillation of recent onset ( < 48 h ) we compared the effects of treatment with continuous intravenous amiodarone 125 mg per hour ( total 3 g ) and intravenous placebo .  Patients in the placebo group who did not convert to normal sinus rhythm within 24 h were started on amiodarone therapy . RESULTS Conversion to normal sinus rhythm occurred within 24 h in 32 of 50 patients ( 64 % ) in the placebo group , most of whom converted within 8 h. Lower conversion rates were observed in patients with hypertension , ischaemic heart disease or congestive heart failure and in patients with echocardiographic findings of left atrial diameter above 45 mm , ejection fraction below 45 % or significant mitral regurgitation . However , in most patients these clinical or echocardiographic risk factors of decreases in conversion rate were not present . In such patients the spontaneous conversion rate was approximately 90 % . The conversion rate during 24 h of treatment in the amiodarone group was 92 % ( P=0.0017 , compared to the placebo group ) . In this group , the conversion rate was largely unaffected by baseline characteristics . Of the 18 patients who did not convert with placebo , 15 ( 85 % ) converted after being crossed over to amiodarone . All patients not responding to high-dose amiodarone were in chronic atrial fibrillation within 1 month . In patients still in atrial fibrillation after 8 h of treatment , the pulse rate decreased significantly more in the amiodarone as compared to the placebo group ( 83+/-15 vs 114+/-20 beats . min(-1 ) , P=0.0014 ) . CONCLUSION The spontaneous conversion of recent onset paroxysmal atrial fibrillation is high and approaches 90 % in specific clinical and echocardiographically defined subgroups . Intravenous high-dose amiodarone safely facilitates conversion of paroxysmal atrial fibrillation . However , such treatment should be reserved for patients with unfavourable risk factor profiles , not converting during 8 h of observation or requiring rate control Abstract Purpose : Atrial fibrillation ( AF ) is a fairly common complication of acute myocardial infa rct ion ( AMI ) . The aim of this study was to examine the safety and efficacy of intravenous amiodarone in converting AF associated with AMI . Methods : Seventy patients with AMI complicated with AF were prospect ively divided into 3 groups : a ) In group D ( n = 26 ) , 0.75 mg digoxin was administered intravenously and thereafter as needed , b ) In group AM ( n = 16 ) , 300 mg of amiodarone was infused over 2 hours followed by 44 mg/hour for up to 60 hours or until sinus rhythm was restored , c ) In group D + AM ( n = 28 ) , 0.75 mg of digoxin was administered ( as in group D ) for the initial 2 hours followed by amiodarone infusion as in group AM . Results : Sinus rhythm was restored : a ) by the end of the 2nd hour in 9/26 patients from group D , 4/16 from group AM , and 10/28 from group D + AM ( p = NS ) , b ) by the end of the 96th hour , in 18/26 patients from group D , and in all patients from group AM and groupd D + AM . The corresponding duration of AF was 51 ± 34 hours , 17 ± 15 hours and 9 ± 13 hours , respectively ( F = 15.4 , p < 0.001 ) . AF recurred in 9/26 , 5/16 and 1/28 patients of groups D , AM and D + AM , respectively ( p = 0.026 ) . The required dosage of amiodarone  was lower in the D + AM group than in the AM group ( 603 ± 563 mg versus 1058 ± 680 mg , p = 0.037 ) . Conclusions : Intravenous amiodarone was well tolerated in patients with AMI complicated by AF and was effective in decreasing the duration of AF . However , the combination of amiodarone and digoxin was superior to amiodarone alone in restoring sinus rhythm faster , maintaining sinus rhythm longer , and allowing the use of a lower cumulative amount of amiodarone Abstract Amiodarone and verapamil are well-known antiarrhythmic drugs used for treatment of ventricular and supraventricular arrhythmias . Although verapamil is the drug of choice for control of the atrioventricular node , it has also been reported to terminate atrial fibrillation . 1–3 Amiodarone has been used extensively for drug-refractory ventricular tachycardia but seldom for termination of paroxysmal atrial fibrillation . 4–6 To our knowledge , no comparative study with amiodarone and verapamil has been reported . Because of this , we compared the efficacy of intravenous amiodarone versus verapamil for conversion of paroxysmal atrial fibrillation to sinus rhythm in a single-blind r and omized study STUDY OBJECTIVE A prospect i ve , r and omized controlled trial of new-onset atrial fibrillation was conducted to compare the efficacy and safety of sotalol and amiodarone ( active treatment ) with rate control by digoxin alone for successful reversion to sinus rhythm at 48 hours . METHODS We prospect ively r and omly assigned 120 patients with atrial fibrillation of less than 24 hours ' duration to treatment with sotalol , amiodarone , or digoxin using a single intravenous dose followed by 48 hours of oral treatment . Patients had ECG monitoring for 48 hours , and time of reversion , adequacy of rate control , and numbers of adverse events were compared . After 48 hours , those still in atrial fibrillation underwent cardioversion according to a st and ardized protocol . After 48 hours of therapy and attempted cardioversion , the number of patients whose rhythms had successfully reverted were compared . RESULTS There was a significant reduction in the time to reversion with both sotalol ( 13 . 0+/-2.5 hours , P < .01 ) and amiodarone ( 18.1+/-2.9 hours , P < .05 ) treatment compared with digoxin only ( 26.9+/-3.4 hours ) . By 48 hours , the active treatment group was significantly more likely to have reverted to sinus rhythm than the rate control group ( 95 % versus 78 % , P < .05 ; risk ratio 5.4 , 95 % confidence interval [ CI ] 1.5 to 19.2 ) . In those patients whose rhythms did not revert to sinus rhythm , there was superior ventricular rate control in the sotalol group at both 24 and 48 hours compared with those who received either amiodarone or digoxin . There were also fewer adverse events in the active treatment group compared with the rate control group . CONCLUSION Immediate pharmacologic therapy for new-onset atrial fibrillation with class III antiarrhythmic drugs ( sotalol or amiodarone ) improves complication-free 48-hour reversion rates compared with rate control with digoxin AIMS A r and omized , double-blind study with a high dose of digoxin administered intravenously for conversion of atrial fibrillation ( not due to haemodynamic alternations ) to sinus rhythm , and for rate control in converters and non-converters was set up . Outcome measures were conversion within 12 h ; time to conversion ; early rate control ; and stable slowing within 12 h. METHODS We studied 40 patients with recent onset ( < 1 week ) atrial fibrillation ; controls received saline intravenously , the other patients digoxin 1.25 mg .  RESULTS One patient converted before digoxin administration . Conversion occurred in 9/19 patients on digoxin and in 8/20 on placebo ( ns ) . The mean time to conversion tended to be shorter only for digoxin . Two late conversions on placebo were observed within 24 h. Heart rate during atrial fibrillation decreased after 30 min for converters and non-converters ( P < 0.05 ) . For all patients on digoxin , heart rate after 30 min was lower compared to baseline ( P < 0.002 ) and to placebo ( P < 0.02 ) . Persistent , stable slowing occurred only in 3/10 non-converters on digoxin ( P < 0.05 ) , and two patients developed bradyarrhythmias . QTc was shortened immediately after conversion in all patients . Converters had baseline characteristics similar to those of non-converters . CONCLUSIONS Intravenous digoxin offers no substantial advantages over placebo in recent onset atrial fibrillation with respect to conversion , and provides weak rate control The efficacy of amiodarone has been proved in long-term maintenance of sinus rhythm ( SR ) in patients with paroxysmal atrial fibrillation ( AF ) . The present study evaluates the efficacy and safety of a single oral dose of amiodarone in patients with recent-onset AF ( < 48 hours ) . Seventy-two patients were r and omized to receive 30 mg/kg of either amiodarone or placebo .  Conversion to SR was verified by 24-hour Holter monitoring . Ten patients were excluded because of SR in the beginning of monitoring or technical failure during Holter monitoring . The remaining study groups were comparable ( n = 31 for each ) , except that in the placebo group beta blockers were more common . The patients receiving amiodarone  converted to SR more effectively than those receiving placebo ( p<0.0001 ) . At 8 hours , approximately 50 % of patients in the amiodarone group and 20 % in the placebo group ( Holter successful ) had converted to SR , whereas after 24 hours the corresponding figures were 87 % and 35 % , respectively . The median time for conversion ( 8.7 hours for amiodarone and 7.9 hours for placebo ) did not differ in the groups . Amiodarone was hemodynamically well tolerated , and the number of adverse events in the study groups was similar . Amiodarone as a single oral dose of 30 mg/kg appears to be effective and safe in patients with recent-onset AF In a r and omized , double-blind , controlled study of 98 patients with atrial fibrillation ( AF ) ( present for > or = 30 minutes , < or = 72 hours , and a ventricular response of > or = 100 beats/min ) , intravenous flecainide ( 2 mg/kg , maximum 150 mg ) was compared with intravenous amiodarone ( 7 mg/kg ) and placebo .  Exclusion criteria included significant left ventricular dysfunction , inotrope dependence , recent antiarrhythmic therapy , hypokalemia , and pacemaker dependence . Reversion to stable sinus rhythm within 2 hours of starting medication was considered likely to be due to drug effect . Twenty of 34 patients ( 59 % ) given flecainide , 11 of 32 ( 34 % ) given amiodarone , and 7 of 32 ( 22 % ) given placebo reverted to stable sinus rhythm in < or = 2 hours after starting medication ( chi-square 9.87 , p = 0.007 ) . More patients reverted to stable rhythm with flecainide than with placebo ( p = 0.005 ; odds ratio 5.1 , 95 % confidence interval 1.54 to 17.5 ) . There was no significant difference between amiodarone and placebo or between flecainide and amiodarone . However , after 8 hours there were no significant differences in reversion between the treatment groups : flecainide ( n = 23 , 68 % ) , amiodarone ( n = 19 , 59 % ) , and placebo ( n = 18 , 56 % ) . Amiodarone promptly reduced the ventricular rate , and this effect was maintained for 8 hours in those whose reversion to stable sinus rhythm was unsuccessful : flecainide was no more effective than placebo in controlling ventricular rate . Adverse effects were not significantly different in the 3 groups . Thus , intravenous flecainide results in earlier reversion of AF than does intravenous amiodarone or placebo . Amiodarone , although less effective in reverting AF , slows the rapid ventricular response . ( ABSTRACT TRUNCATED AT 250 WORDS Summary : Thirty-four patients with atrial fibrillation complicating suspected acute myocardial infa rct ion were r and omised to treatment with intravenous amiodarone ( n = 18 ) or intravenous digoxin ( n = 16 ) . After 24 h , similar proportions of patients in each group had reverted to sinus rhythm . However , there was a tendency towards earlier reversion with amiodarone . At 4 h , 72 % of the amiodarone group had reverted to sinus rhythm , compared with 31 % of the digoxin group ( p < 0.1 ) . This tendency was more marked in patients with definite infa rct ion ( at 4 h , amiodarone 75 % reversion , digoxin 10 % reversion ) . Neither drug had a significant effect on blood pressure . Atrial fibrillation may cause serious haemodynamic deterioration in acute myocardial infa rct ion . In comparison with digoxin , amiodarone offers more rapid control of the ventricular response rate and may , in addition , restore sinus rhythm more rapidly BACKGROUND There are two approaches to the treatment of atrial fibrillation : one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm , and the other is the use of rate-controlling drugs , allowing atrial fibrillation to persist . In both approaches , the use of anticoagulant drugs is recommended . METHODS We conducted a r and omized , multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death . The primary end point was overall mortality . RESULTS A total of 4060 patients ( mean [ + /-SD ] age , 69.7+/-9.0 years ) were enrolled in the study ; 70.8 percent had a history of hypertension , and 38.2 percent had coronary artery disease . Of the 3311 patients with echocardiograms , the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent . There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy ( mortality at five years , 23.8 percent and 21.3 percent , respectively ; hazard ratio , 1.15 [ 95 percent confidence interval , 0.99 to 1.34 ] ; P=0.08 ) . More patients in the rhythm-control group than in the rate-control group were hospitalized , and there were more adverse drug effects in the rhythm-control group as well . In both groups , the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic . CONCLUSIONS Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy , and there are potential advantages , such as a lower risk of adverse drug effects , with the rate-control strategy . Anticoagulation should be continued in this group of high-risk patients Sixty-two patients with recent-onset ( less than or equal to 1 week ) atrial fibrillation ( New York Heart Association functional class 1 and 2 ) were r and omized in a single-blind study to 1 of the following treatment groups : ( 1 ) flecainide ( 300 mg ) as a single oral loading dose ; or ( 2 ) amiodarone ( 5 mg/kg ) as an intravenous bolus , followed by 1.8 g/day ; or ( 3 ) placebo for the first 8 hours . Twenty-four-hour Holter recording was performed , and conversion to sinus rhythm at 3 , 8 , 12 and 24 hours was considered as the criterion of efficacy . Conversion to sinus rhythm was achieved within 8 hours ( placebo-controlled period ) in 20 of 22 patients ( 91 % ) treated with flecainide , 7 of 19 ( 37 % ) treated with amiodarone ( p less than 0.001 vs flecainide ) , and 10 of 21 ( 48 % ) treated with placebo ( p less than 0.01 vs flecainide ) . Resumption of sinus rhythm within 24 hours occurred in 21 of 22 patients ( 95 % ) with flecainide and in 17 of 19 ( 89 % ) with amiodarone ( p = not significant ) . Mean conversion times were shorter for flecainide ( 190 + /- 147 minutes ) than for amiodarone ( 705 + /- 418 ; p less than 0.001 ) . No major side effects occurred . At Holter monitoring , a pause of 9.3 seconds was observed in 1 asymptomatic patient treated with flecainide . Phases of atrial flutter with a ventricular rate less than or equal to 150 beats/min were detected before sinus conversion in 1 patient receiving placebo and in 2 receiving flecainide . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Electric conversion of atrial fibrillation is the most widely used and effective treatment for sinus rhythm restoration . However , it has a limited success rate and a high recurrence rate . HYPOTHESIS Pretreatment with calcium channel blocker may improve the efficacy by reversing the so-called " electric remodeling " phenomenon , also related to overload in cytosolic calcium . METHODS The efficacy of diltiazem or amiodarone pretreatment ( oral , 1 month before and 1 month after conversion ) on direct-current conversion of persistent atrial fibrillation was assessed in 120 patients , r and omly assigned to 3 matched groups : A ( n = 44 , diltiazem ) ; B ( n = 46 , amiodarone ) , and C ( n = 30 , digoxin ) . RESULTS Before electric conversion , all treatments significantly decreased mean heart rate . Spontaneous conversion to sinus rhythm was achieved in 6 % of patients of group A ( 3 of 46 ) versus 25 % of group B ( 11 of 44 ) and 3 % ( 1 of 30 ) of group C ( A/C vs B , P < .005 ) . Current conversion was more successful in group B ( 91 % ) compared with group A ( 76 % ) and group C ( 67 % ) ( B vs A/C , P < .05 ) , with no difference in the electric threshold for effective conversion ( P = not significant ) . At the 24-hour time point , early relapse of atrial fibrillation was similar between groups A and B ( A , 2 % ; B , 3 % ; P = not significant ) and lower than group C ( 12 % ) ( P < .01 ) , whereas at the 1-month time point the recurrence rate was lower in group B ( 28 % ) versus groups A ( 56 % ) and C ( 78 % ) ( B vs A/C , P < .01 ) . No significant side effects were reported . CONCLUSIONS Although diltiazem seems to be as effective as amiodarone in reducing early atrial fibrillation recurrences , diltiazem is less effective in determining spontaneous or electric conversion , with a higher recurrence rate at 2 months . Diltiazem pretreatment could be considered as only a second choice treatment in those patients in whom amiodarone is contraindicated AIMS The DAAF Trial was design ed to investigate whether digoxin , within 16 h of its use , increases the rate of conversion to sinus rhythm in patients with acute atrial fibrillation . METHODS AND RESULTS In a r and omized , double-blind multicentre trial the effects of intravenous digoxin and placebo , ( mean dose 0.88 + /- 0.35 mg and 0.96 + /- 0.37 mg ) were compared in 239 patients with a mean age of 66.2 + /- 13.0 years and atrial fibrillation of , at most , 7 days ' duration . The mean arrhythmia duration was 21.7 + /- 30.4 h and baseline heart rate 122.0 + /- 23.0 beats.min-1 . At 16 h , 46 % of the placebo group and 51 % of the digoxin group had converted to sinus rhythm , ( ns ) . Time to sinus rhythm was shorter in the digoxin group , but the difference was not significant . Digoxin had a pronounced and rapid effect on heart rate , which was already significant at 2 h ; 104.6 + /- 20.9 beats.min-1 vs 116.8 + /- 22.5 beats.min-1 ( P = 0.0001 ) . CONCLUSION Acute intravenous treatment with digoxin does not increase the rate of conversion to sinus rhythm , but has a fast acting and clinical ly significant effect on heart rate and should remain an alternative in haemodynamically stable patients
target: We found that the size of the left atrium , presence of cardiovascular disease , and protocol s of amiodarone administration did not influence the magnitude of effect .
  Serious adverse events were infrequent .
  Amiodarone is effective for converting AF to sinus rhythm in a wide range of patients .
background: BACKGROUND Although clinicians sometimes choose amiodarone to convert atrial fibrillation ( AF ) to sinus rhythm , no current and comprehensive systematic review has summarized its effectiveness .
  OBJECTIVE To review the effectiveness of amiodarone in converting AF to sinus rhythm over a 4-week period .