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Thirty-four patients with atrial fibrillation complicating suspected acute myocardial infarction were randomised to treatment with intravenous amiodarone (n = 18) or intravenous digoxin (n = 16). After 24 h, similar proportions of patients in each group had reverted to sinus rhythm. However, there was a tendency towards earlier reversion with amiodarone. At 4 h, 72% of the amiodarone group had reverted to sinus rhythm, compared with 31% of the digoxin group (p less than 0.1). This tendency was more marked in patients with definite infarction (at 4 h, amiodarone 75% reversion, digoxin 10% reversion). Neither drug had a significant effect on blood pressure. Atrial fibrillation may cause serious haemodynamic deterioration in acute myocardial infarction. In comparison with digoxin, amiodarone offers more rapid control of the ventricular response rate and may, in addition, restore sinus rhythm more rapidly.
Cowan et al. (1986) studied this question.