Evaluation of Two Different Regimens of the Antiarrhythmic Drug Amiodarone to Maintain Normal Sinus Rhythm After Electrical Cardioversion in Patients With Persistent Atrial Fibrillation

Inclusion criteria

• Patients aged ≥ 18 years
• Documented persistent atrial fibrillation (≥ 7 days in duration)
• Electively referred for Electrical Cardioversion
• Signed informed consent.

Exclusion criteria

• Urgent electrical cardioversion
• Atrial fibrillation post-cardiac surgery
• Previous myocardial infarction
• New York Heart Association (NYHA) Class IV heart failure
• Left ventricular ejection fraction (LVEF) <45%
• Significant left ventricular hypertrophy (wall thickness ≥ 15mm)
• Hyperthyroidism or hypothyroidism
• Known hepatobiliary disease (acute hepatitis, cirrhosis...) or ALT/AST > 3 x upper limit of normal (ULN)
• Allergy, intolerance, or known hypersensitivity to study medications
• Women of childbearing potential unwilling to use contraceptive measures and breastfeeding women.
• Participation in another clinical trial involving investigational drugs
• Life expectancy less than 12 months
• Rheumatic mitral stenosis of any degree or severe mitral or aortic valve dysfunction.
• Patients with contraindications to amiodarone, such as uncontrolled thyroid dysfunction, severe sinus bradycardia, second- or third-degree AV block without a pacemaker, and a history of amiodarone-induced pulmonary toxicity.
• Patients in whom chronic amiodarone treatment previously failed to maintain sinus rhythm
• Patients with abnormal baseline QTc (>450 ms in males and >470 in females) or abnormal ECG that precludes QTc assessment
• Patients requiring concomitant medications that have a higher risk of QTc prolongation.
• Patient do not have a smart mobile phone or do not know how to use it adequately.