Clinical Factors Associated with Amiodarone Prescription at Hospital Discharge in Patients with Atrial Fibrillation: Insights from the CRAFT Registry

Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and remains a major clinical challenge. Despite advances in catheter ablation, antiarrhythmic drugs continue to play an important role in rhythm-control therapy. Amiodarone is one of the most effective agents, particularly in patients with structural heart disease or heart failure. Methods This retrospective analysis was based on data from the CRAFT registry ( MultiCenter expeRience in AFib patients Treated with oral anticoagulation), including consecutive patients with AF hospitalized in a cardiology department between 2017 and 2024. The clinical characteristics, comorbidities, laboratory results, and pharmacotherapy were analyzed. Multivariable logistic regression was used to identify the factors associated with amiodarone therapy. Results The study population included 2,914 patients, of whom 593 (20%) received amiodarone. Amiodarone therapy was independently associated with paroxysmal or persistent atrial fibrillation, prior electrical cardioversion, younger age, heart failure with reduced ejection fraction (HFrEF), direct oral anticoagulants use, and guideline-directed medical therapy for heart failure. Conclusions In this large real-world AF registry, amiodarone therapy was used in approximately 20% of patients and was primarily associated with rhythm-control strategies and clinical characteristics consistent with current guidelines. These findings provide insights into contemporary decision-making regarding antiarrhythmic therapy for AF.