Intravenous Amiodarone Restores Sinus Rhythm in Acute Myocardial Infarction Complicated with Atrial Fibrillation

The effectiveness and tolerance of intravenous (IV) amiodarone (Am) in atrial fibrillation (AF) complicated acute myocardial infarction (AMI) is not well studied. Thus, twenty patients (Pts) with AMI complicated with AF occurring within 30 h (11.9 ± 10) of the onset of AMI symptoms were treated with IV administration of digitalis (d, 0.5 mg and an additional 0.25 mg later) followed by IV Am 300 mg over 2 h (starting 2 h after the initial dose of d) and followed by 44 mg/h for up to 3 days, if sinus rhythm (SR) was not restored. Intravenous d restored SR within 2 h in pts. AF relapsed in 2 of them. Subsequent administration of Am for 2 h restored SR in the remaining pts and in the 2 pts in whom AF had relapsed after the initial restoration of SR by d. Am restored SR within an average of 12.8 (range 0.5-56) h of infusion. Total dose of Am was 1922 ± 720 mg in 4 pts and 425 ± 241 mg in the remaining 13. Am was well tolerated by all pts including 1 with cardiogenic shock assisted with the intraaortic balloon pump. In conclusion, IV Am administration is highly effective in restoring sinus rhythm in AF complicating AMI and is well tolerated.