Efficacy and safety of amiodarone in patients with atrial fibrillation in the era of target-specific anticoagulants.

SEE PAGE 1541 I n patients with atrial fibrillation (AF), loss of organized atrial contraction and accelerated ventricular rate can have both immediate and longterm adverse consequences, including deterioration of hemodynamics, progressive atrial and ventricular dysfunction, and an ongoing risk of ischemic stroke and systemic embolic events (SEEs). The principal goals of therapy are control of symptoms and prevention of thromboembolism. The AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) trial and other studies demonstrated that both rate control and rhythm control strategies improve symptoms in patients with AF, but neither of these strategies is associated with better survival or a lower risk of ischemic stroke than the other (1). Patients with AF and additional risk factors for thromboembolism require long-term anticoagulation, even after sinus rhythm has been restored. The 2014 American College of Cardiology/American Heart Association/Heart Rhythm Society AF guidelines recommend antiarrhythmic drug therapy to reduce the frequency and duration of episodes and improve quality of life in patients with paroxysmal or persistent AF (2). The class III antiarrhythmic drug, amiodarone, is currently the most effective available agent. Amiodarone is recommended for patients with frequent,