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March 11, 2009

Treatment With Amiodarone to Prevent Atrial Fibrillation—Reply

JAMA. 2009;301(10):1019-1020. doi:10.1001/jama.2009.264

In Reply: As noted by Dr Santangeli and colleagues, the episodic amiodarone treatment group had significantly larger left atria compared with the continuous amiodarone treatment group. On the other hand, a nonsignificantly greater number of patients in the episodic amiodarone treatment group were using ACE inhibitors, with comparable blood pressure measurements at baseline and history of hypertension. Along with smaller atrial size, the use of ACE inhibitors and angiotensin II receptor blockers are predictors for sinus rhythm maintenance in union with amiodarone therapy.1 Statins may also play a role in prevention of atrial fibrillation due to pleiotropic effects such as attenuation of inflammation and antioxidant effects.2 We are currently conducting a subanalysis to find predictors for the maintenance of sinus rhythm in both treatment groups.