Effectiveness and safety of Amiodarone in the treatment of atrail fibrillation.

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia (Fuster et al., 2006). AF leads to deleterious consequences like congestive heart failure, stroke and death (Stewart et al., 2002). Hence, the proper management of AF is essential. Several antiarrythmic drug treatment options are available. The most commonly drug used locally is Amiodarone. Research Question: In adults with AF (the patient/problem), is Amiodarone (the intervention) more effective and safer than other anti-arrhythmic drugs (comparison intervention) in maintaining normal sinus rhythm (expected outcome)? The method: The inclusion criteria were: randomized control trials, systematic reviews and meta analysis reports published in English after the year 2000, in full text, involving male and female participants aged > 18 years, comparing amiodarone with any other antiarrythmic drug. The exclusion criteria were articles not in full text, published prior to the year 2000, which involved alternative therapies. The literature search retrieved four Randomized Control Trials and two Systematic Reviews. Tools from the Critical Appraisal Skills Programme were used to appraise the evidence. The keywords used were; 'Atrial Fibrillation,' 'Amiodarone,' 'Safety,' and 'Efficacy'. Results: All antiarrythmic drugs are better than no treatment in maintaining sinus rhythm. Amiodarone is more effective in maintaining SR in the long term, but has a very low safety profile. Dronaderone showed fewer side effects, but an increased mortality rate in patients with congestive heart failure. Sotalol proved to be more effective than amiodarone in patients with ischemic heart disease only. Further research is needed to achieve the evidence for best treatment to specific patient groups. Recommendation: Further research on treatments available in AF such as amiodarone and ablation therapy. Implication: No studies were carried out in Malta thus no evidence is known on how the Maltese population reacts to the treatment given.