ABSTRACT
Amiodarone may be used to control AF acutely. Intravenous (via a central venous line) or oral loading may be used depending upon the clinical situation. The usual maintainence dose of 200 mg daily is often sufficient to control AF in the long term, although some patients may be able to discontinue amiodarone once β-blockers have been titrated up to an antiarrhythmic dose (220). This approach avoids the serious long-term side-effects of amiodarone (Table 38). Amiodarone may affect levels of other common drugs used in HF, notably warfarin and digoxin. Close monitoring of the international normalized ratio (INR), together with an approximate halving of the dose of warfarin, is needed when commencing amiodarone. Dofetilide, a new class III antiarrhythmic agent, may be an alternative to amiodarone for the control of AF (221). Both amiodarone and dofetilide may prolong the QTc interval, with an associated risk of torsade de pointes ventricular tachycardia.
