Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Kapoor addresses the important issue of rate- vs rhythm-control strategy for AF. We agree that symptomatic patients with persistent AF may benefit from a rhythm-control strategy and recommend therapeutic choices be made on an individual basis. We do not dispute the efficacy of amiodarone in treatment of AF. However, there are other efficacious antiarrhythmics for restoration and maintenance of sinus rhythm that pose less long-term patient risk. For example, the SAFE-T investigators found sotalol and amiodarone similarly efficacious in patients with ischemic heart disease.1 SAFE-T followed up patients (mean age, 67.1 [SD, 9.3] years) for a mean of 3.5 years. In the AFFIRM trial,2 patients (mean age, 69.7 [SD, 9.0] years) were likewise followed up for a mean of 3.5 years. This period may not adequately reflect the impact of adverse effects on younger patients treated with amiodarone. The AFFIRM investigators noted that patients with AF often need treatment for decades, not years.
Vassallo P, Trohman RG. Use of Amiodarone—Reply. JAMA. 2007;298(22):2617-2618. doi:10.1001/jama.298.22.2618-a