Secondary Prevention of Nonvalvular Atrial Fibrillation: A Retrospective Cohort Study

Background: Secondary prevention of atrial fibrillation (AF) could be carried out by means of antiarrhythmic drugs; however this strategy has not received any endorsement because these drugs are burdened by a high risk of proarrhythmic events (flecainide, sotalol) or extracardiac effects (amiodarone). Methods: In our retrospective cohort study we have compared amiodarone 200 mg per day with the strategy implying the renunciation of any specific drug as well as with the approach using oral anticoagulant (rivaroxaban) or a combined approach including amiodarone plus rivaroxaban. Results: A total of 255 patients with a history of AF (paroxysmal, persistent or long-lasting persistent) successfully treated with achievement of sinus rhythm have been gathered. Amiodarone has been the most effective option for AF secondary prevention, with regard to the recurrences of AF as well as rehospitalizations: P (Kruskal-Wallis test) < 0.05 for both, over a median follow-up of 24 months. Conclusions: Patients kept free from any specific drug therapy have been shown to experience more numerous AF relapses and related rehospitalizations. On the contrary, the amiodarone use has been associated with a decreased risk of AF recurrences and hospital admissions. Thus, amiodarone might be an efficacious tool for realizing a successful long-term AF secondary prevention.