An update on amiodarone treatment for atrial fibrillation : efficacy versus safety

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and the incidence of AF is set to rise further as the general population in the Western world achieves greater age. Rhythm control remains therapy of choice in symptomatic patients. Large clinical trials have shown, however, that AF treatment aimed at attaining long-term successful rhythm control is still far from optimal. Amiodarone, a class IIIl antiarrhythmic drug with additional class I, II and IV activities, has been shown to be the most effective drug for sinus rhythm maintenance in patients with persistent AF. Amiodarone therapy is, however, often accompanied by the occurrence of serious adverse events, thought to be associated with long-term treatment. The aim of this thesis is to evaluate whether alternative strategies of amiodarone therapy may reduce amiodarone-related adverse events while being safe and effective at the same time. Furthermore, this thesis investigated amiodarone-associated adverse events, especially thyroid dysfunction, and the effect of amiodarone treatment on quality of life. Finally, the role of Type D personality (the conjoined effect of negative affectivity and social inhibition) on AF treatment outcome in amiodarone treated patients was studied.

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