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To the Editor: Atrial fibrillation (AF) is the most common arrhythmia leading to patient hospitalization.^1-2 In their Clinical Review, Drs Vassallo and Trohman³ discuss the use of amiodarone for treatment of AF. They state that "because AFFIRM demonstrated no significant differences in stroke, quality of life, or mortality with rhythm vs rate control, physicians must consider the risk-benefit ratio of antiarrhythmic drugs to maintain sinus rhythm."

However, data from SAFE-T,⁴ a double-blind, placebo-controlled trial, suggest that quality of life and exercise capacity can improve with the use of antiarrhythmic drugs in patients with persistent AF. Anticoagulated patients were randomly assigned to amiodarone, sotalol, or placebo groups and followed up for a mean of 3.5 years. Physical functioning, general health, and social functioning were significantly better in the group in sinus rhythm, and there was a statistically nonsignificant improvement in vitality scores. Another clinically pertinent finding was the lack of significant . . . [Full Text of this Article]

John R. Kapoor, MD, PhD
jkapoor@stanford.edu
Division of Cardiology
Stanford University
Stanford, California

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