LOW-DOSE AMIODARONE VERSUS SOTALOL FOR SUPPRESSION OF RECURRENT SYMPTOMATIC ATRIAL-FIBRILLATION

To compare the safety and efficacy of amiodarone and sotalol in the tr eatment of patients with recurrent symptomatic atrial fibrillation (AF ), 70 patients were entered into a randomized, double-blind study. Of these, 35 received amiodarone and 35 sotalol. There were no significan t differences in baseline clinical characteristics between groups. Pat ients with ejection fraction <40% or clinically significant heart dise ase were excluded. Patients randomized to amiodarone began with 800 to 1,600 mg/day for 7 to 14 days orally. After the initial loading phase , the drug dose was tapered to maintenance levels over 7 to 12 days; t hereafter, therapy was generally maintained; a, a dosage of 200 mg/day . The sotalol dosage was 80 to 360 mg twice daily, as tolerated. Follo w-up clinical evaluations were conducted at 1, 2, 4, 6, 9, and 12 mont hs. The proportion of patients remaining in sinus rhythm on each agent was calculated for the 2 groups using the Kaplan-Meier method. Ten of the 35 patients who were taking amiodarone developed AF during the 12 -month observation period, compared with 21 of the 35 who were taking sotalol (p = 0.008). No significant effect of sex, age, left atrial si ze, or type of AF could be detected that increased the risk of develop ment of AF. We conclude that both amiodarone and sotalol can be used f or the maintenance of normal sinus rhythm in patients with recurrent s ymptomatic AF but that amiodarone is the more effective of the 2 drugs for this purpose. (C) 1998 by Excerpta Medica, Inc.