Although amiodarone is approved by the US Foodand Drug Administration only for refractory ventricular arrhythmias,it is one of the most frequently prescribed antiarrhythmic medicationsin the United States.

Objective was To evaluate and synthesize evidence regardingoptimal use of amiodarone for various arrhythmias.

Systematic search of MEDLINE to identifypeer-reviewed clinical trials, randomized controlled trials,meta-analyses, and other studies with clinical pertinence. Thesearch was limited to human-participant, English-language reportspublished between 1970 and 2007. Amiodarone was searched usingthe terms adverse effects, atrial fibrillation, atrial flutter,congestive heart failure, electrical storm, hypertrophic cardiomyopathy,implantable cardioverter-defibrillator, surgery, ventriculararrhythmia, ventricular fibrillation, and Wolff-Parkinson-White.Bibliographies of identified articles and guidelines from officialsocieties were reviewed for additional references. Ninety-twoidentified studies met inclusion criteria and were includedin the review.

Amiodarone may have clinical valuein patients with left ventricular dysfunction and heart failureas first-line treatment for atrial fibrillation, though otheragents are available. Amiodarone is useful in acute managementof sustained ventricular tachyarrythmias, regardless of hemodynamicstability. The only role for prophylactic amiodarone is in theperioperative period of cardiac surgery. Amiodarone may be effectiveas an adjunct to implantable cardioverter-defibrillator therapyto reduce number of shocks. However, amiodarone has a numberof serious adverse effects, including corneal microdeposits(>90%), optic neuropathy/neuritis ( 1%-2%), blue-gray skindiscoloration (4%-9%), photosensitivity (25%-75%), hypothyroidism(6%), hyperthyroidism (0.9%-2%), pulmonary toxicity (1%-17%),peripheral neuropathy (0.3% annually), and hepatotoxicity (elevatedenzyme levels, 15%-30%; hepatitis and cirrhosis, <3% [0.6%annually]).

Amiodarone should be used with close follow-upin patients who are likely to derive the most benefit, namelythose with atrial fibrillation and left ventricular dysfunction,those with acute sustained ventricular arrhythmias, those aboutto undergo cardiac surgery, and those with implantable cardioverter-defibrillatorsand symptomatic shocks.

source :JAMA. 2007;298:1312-1322.