Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 334 AFRICA amiodarone had a lower side-effect rate than class I AADs and no clear difference was observed between amiodarone and sotalol or dronedarone. Another large cohort study on amiodarone and mortality retrospectively enrolled 141 500 patients with AF. They did not find a significant increase in risk of death with amiodarone use. 117,118 The TREAT-AF study included 122 465 patients with newly diagnosed AF and found that amiodarone use was not associated with increased risk of death. 119 This study also included the largest cohort with concomitant AF and heart failure on amiodarone therapy and reported no association between amiodarone and increased mortality rates in patients with a diagnosis of heart failure at baseline. Based on studies that compared amiodarone with other AADs, we propose the clinical approach outlined in Fig. 1 for SR maintenance after cardioversion or catheter ablation. Conclusion AF is a time bomb. The high and continuously increasing prevalence of AF has led to a real pandemic of heart problems, which has a negative impact on patients’ quality of life. Rapid treatment with cardioversion and prevention of other episodes is essential, given the vicious circle known as ‘fibrillation induces fibrillation’. Over the last 45 years, amiodarone has been used extensively in all countries of the world. The experience and knowledge Clinical approach to the management of patients before cardioversion or catheter ablation Does the patient need catheter ablation of AF Does the patient need pharmacological or electrical cardioversion? Y E S Y E S Monitor for side effects • ECG • Liver function • Thyroid function • Chest radiography • Eye examination Switch on other class III, class IA or IC Switch on other class III, class IA or IC In case of long- durtion use of amiodarone In case of long- durtion use of amiodarone Use short- duration amniodrone for 90 days Use short-duration amiodarone for 90 days.It will reduce early AF recurrences but not late recurrences Choose amiodarone over class IA,IC or other class III anti-arrhythmic drugs • ECG • Liver function • Thyroid function • Chest radiography • Eye examination Monitor for side effects Not tolerated Not tolerated Fig. 1. Clinical approach for maintenance of sinus rhythm after cardioversion or catheter ablation.