Efficacy of i.v. amiodarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients

Twenty-six consecutive patients (14 males, 12 females—meanage 66.6) were admitted to an intensive care unit (ICU) becauseof a rapid ventricular response to atrial fibrillation (RAF).Fourteen of them had been unsuccessfully treated by drugs (otherthan amiodarone) and/or DC shock before admission. A loading dose of i.v. amiodarone was administered (repeatedboluses of 3 mg/kg in 3 min, or 30 min-infusions of 5 to 7.5mg/kg), followed by continuous infusion, in order to reach amaximal total dosage of 1500 mg in 24 h. This treatment was considered efficacious if a reversion tostable sinus rhythm (SSR) occurred within 24 h and was maintainedfor more than 48 h. This was achieved in 21 out of 26 patients(80.8%). The mean time between the administration of therapyand the occurrence of SSR was 171 min. The total dose of amiodaronedelivered to effect SSR was 6.9 ± 2.3 mg/kg. No adversereactions were encountered during the bolus injection but werecommend that continuous infusion be carried out through acentral venous catheter to avoid phlebitis. The administration of 7 mg/kg of intravenous amiodarone deliveredin 30 min proved a safe and successful first choice of managementin atrial fibrillation with a rapid ventricular response.