Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation - Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation
The goal of the trial was to evaluate the efficacy and safety of rapid high-dose intravenous infusions of amiodarone, sotalol or digoxin for heart rate control and rapid reversion to sinus rhythm in patients with recent symptomatic atrial fibrillation.
Patients Enrolled: 140
Mean Follow Up: Hospital discharge
Mean Patient Age: mean age 56 years
Presentation at the emergency department with symptomatic atrial fibrillation
Use of amiodarone or sotalol in the preceding month; previous adverse reaction to a trial drug; previous atrial fibrillation while taking amiodarone or sotalol; asthma or chronic airway limitation; signs or symptoms of heart failure; known or suspected pulmonary fibrosis; pregnancy; uncorrectable hypotension (<90 mm Hg); sick sinus syndrome; bradycardia (<50 beats/min); QTc >450 ms; active hepatitis; postoperative patients (<1 month)
Rate of reversion to sinus rhythm
Patients presenting to the emergency department with recent symptomatic atrial fibrillation were randomized to sotalol (1.5mg/kg infused in 10 minutes; n=45), amiodarone (10mg/kg in 30 minutes; n=52), or digoxin (500 μg in 20 minutes; n=43).
If patients did not convert to sinus rhythm within 12 hours, electrical cardioversion was used.
Rate control occurred more quickly with rapid infusion of sotalol or amiodarone compared with digoxin. Rate control was significantly better than digoxin with sotalol at 30 minutes (p<0.005), 3 hours (p<0.005), and 6 hours (p<0.032), and was better with amiodarone at 30 minutes and 3 hours (p=0.02 for both). There was no significant difference in pharmacological conversion to sinus rhythm by treatment group (51% with amiodarone, 44% with sotalol, 50% with digoxin, p=NS). Cardioversion after study drug infusion and defibrillation, which was high in all 3 groups, did not differ between treatment groups (94% with amiodarone, 95% with sotalol, and 98% with digoxin, p=NS). Serious adverse reactions trended higher in the amiodarone group (n=7), including symptomatic hypotension (n=5, p=0.035).
Among patients with recent symptomatic atrial fibrillation, treatment with rapid infusion of sotalol or amiodarone was associated with improved rate control compared with digoxin but there was no significant difference in the time to cardioversion between the treatment groups. Additionally, there was a trend for an increase in serious adverse events with amiodarone.
Thomas SP, et al. Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial. Am Heart J 2004 Jan;147(1):E3.
Keywords: Digoxin, Electric Countershock, Hypotension, Sotalol, Emergency Service, Hospital, Infusions, Intravenous, Heart Rate
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