Would you start an amiodarone load for new onset atrial fibrillation with RVR intermittently in normal sinus rhythm to further suppress AF recurrence in the acute setting?

The answer to this question really depends on the clinical scenario. Does the patient have a structurally normal heart? Is this a post-op setting where the AF is expected to settle down with time? Age of patient? Co-morbidities? Candidacy for less toxic drugs or ablation?

If this were a post-op patient with new onset PAF with RVR, I think the use of amiodarone short term (few months) is a very reasonable option since the AF will likely subside once any fluid and electrolyte shift settles down an...

This is really a two-part question:

• Would you use amiodarone for acute pharmacologic conversion of new-onset afib? Routinely, I say NO.
• Would you continue amiodarone for the maintenance of rhythm control? Routinely, I say NO.

For part 1), we can look back at the 2014 ACC AHA HRS Afib guidelines (January et al., PMID 24685669) that talk about pharmacologic conversion. Preferred (class I indicated) agents are oral flecainide and propafenone (pill in pocket - in the NEJM study tested with ER observ...