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Intravenous amiodarone for acute pharmacological conversion of atrial fibrillation in the emergency department

Published online by Cambridge University Press:  21 May 2015

Richard S. Slavik
Richard S. Slavik*
Affiliation:
Clinical Services Unit — Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, Vancouver, BC; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
*
Clinical Services Unit — Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, 855 West 12th Ave., Vancouver BC V5Z 1M9; 604 875-4077, fax 604 875-5267, rslavik@interchange.ubc.ca

Abstract

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Atrial fibrillation (AF) is the most common arrhythmia seen in patients presenting to the emergency department (ED). Pharmacological conversion of atrial fibrillation to normal sinus rhythm (NSR) may be a feasible management strategy in selected patients. Recent guidelines have recommended intravenous amiodarone, a class III antiarrhythmic agent, for the conversion of AF to NSR. The purpose of this review is to examine the published evidence for the efficacy of IV amiodarone for the acute conversion of AF to NSR in the ED. Currently available data from 11 randomized, controlled trials and 3 meta analyses do not support the use of conventional doses of IV amiodarone for acute conversion in the ED. High dose IV or combined IV and oral administration may be effective as early as 8 hours in patients with recent-onset AF of ≤48 hour duration in patients without contraindications to these high dose regimens. There are no data to support the use of IV amiodarone for acute conversion in patients with an ejection fraction of <40% or clinical heart failure, so its use in these scenarios should be limited to symptomatic patients who are refractory to electrical conversion. More well-designed studies are required to determine the role of IV amiodarone for the acute conversion of AF in the ED.

Keywords

amiodaroneatrial fibrillationconversionantiarrhythmic agents
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 6 , November 2002 , pp. 414 - 420
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

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