Prevention

Why?

• It prevents reversion to AF better than sotalol ^a or disopyramide ^a   following DC cardioversion 

Paroxysmal AF: amiodarone prevents recurrence of AF better than sotalol

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
cardioverted paroxsymal or chronic AF a	amiodarone	sotalol	recurrence of AF at 12 months	60%	52% (14% to 74%)	3 (2 to 11)

• However adverse effects are common and often lead to patients stopping ^a

Many patients on long-term low-dose amiodarone discontinue medication due to adverse effects

Patient	Treatment	Comparison	Outcome	CER	NNH (95% CI)
on oral amiodarone a	low-dose amiodarone	no amiodarone	drug discontinued at 12 months	15.4%	14 (8 to 36)
			neurological disturbance at 12 months	1.9%	54 (21 to 590)
			bradycardia at 12 months	1.4%	63 (24 to 670)
			thyroid disease at 12 months	0.4%	76 (32 to 240)
			skin rash at 12 months	0.7%	100 (29 to 2900)
			visual complaints at 12 months	0.1%	300 (85 to 3300)

Note:

• Arrhythmias due to amiodarone are uncommon, (2.8%: 95% CI: 2.1% to 3.5%) particularly torsade de pointes (0.7%: 95% CI: 0.5% to 1.4%) ^b
• High doses of amiodarone increase the risk of developing pulmonary toxicity (5.8% of patients on 50 to 800 mg daily: 95% CI: 3.9% to 7.7%) ^c