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J R Soc Med 2006;99:220
doi:10.1258/jrsm.99.5.220-a
© 2006 Royal Society of Medicine

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J R Soc Med 2006;99:220
© 2006 The Royal Society of Medicine

Letters

Inadvertent toxic drug reaction in the management of atrial fibrillation

Oscar Jolobe

Tameside General Hospital, Ashton-under-Lyne OL6 9RW, UK

E-mail: oscarjolobe{at}yahoo.co.uk

The choice of either sotalol or amiodarone for rhythm control was a feature of the management of a case presented by Leaver and Ho (March 2006 JRSM1) which was even more problematic than the inadvertent choice of adversely interacting drugs. Although amiodarone was the final choice of antiarrhythmic agent, presumably because of its superior efficacy in preventing relapse of atrial fibrillation (AF),2 it is a drug now known to be associated with relapse rates of the order of >90%.3,4 Accordingly, so long as the long-term antiarrhythmic management of AF involves drugs, which are not strikingly superior to amiodarone in their efficacy—even with the benefit of adjunctive electrical cardio-version3—the verdict from the AFFIRM study5 will prevail. In paraphrase, the verdict from AFFIRM is that failed rhythm control is a poor substitute for successful rate control.

REFERENCES

  1. Leaver S, Ho TB. Inadvertent toxic drug reaction in the management of atrial fibrillation. J R Soc Med2006; 99:149 -50[Free Full Text]

  2. Singh BN, Singh SN, Reda SJ, et al. Amiodarone v sotalol for atrial fibrillation. N Engl J Med2005; 352:1861 -72[Abstract/Free Full Text]

  3. Oral H, Pappone C, Chugh A, et al. Circumferential pulmonary—vein ablation for chronic atrial fibrillation. N Engl J Med 2006;354:934 -41[Abstract/Free Full Text]

  4. Stabile G, Bertaglia E, Senatore G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multicentre, randomised, controlled study (Catheter Ablation For the Cure of Atrial Fibrillation study). Eur Heart J2006; 27:216 -21[Abstract/Free Full Text]

  5. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825 -33[Abstract/Free Full Text]


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This Article
Right arrow Full Text (PDF)
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