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To the Editor: In their trial of treatment to prevent atrial fibrillation, Dr Ahmed and colleagues¹ reported more atrial fibrillation recurrences, all-cause mortality, and bleeding complications in patients with atrial fibrillation undergoing electrical cardioversion who were randomized to receive episodic amiodarone treatment compared with those who received continuous treatment. However, there are several issues that may have affected the validity of the conclusions.

The authors reported unadjusted survival curves for all of the prespecified end points. However, the episodic amiodarone group had significantly larger left atria (P = .01 for the long axis measurements), and atrial size has been shown to predict atrial fibrillation recurrences.² Therefore, the higher atrial fibrillation recurrence rate in that group cannot be attributed solely to the different treatment strategy.

Moreover, the choice of a high intensity of anticoagulation (targeted international normalized ratio [INR] between 2.5 and 3.5),³ and the lack of data on the INR . . . [Full Text of this Article]

Pasquale Santangeli, MD
pasquale.santangeli@libero.it

Antonio Dello Russo, MD; Fulvio Bellocci, MD
Cardiovascular Department
Catholic University
Rome, Italy

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