The Double-Edged Sword of Amiodarone in Atrial Fibrillation: Efficacy vs. Toxicity in a North African Cohort

Background: Cordarone (amiodarone) is the most effective antiarrhythmic for atrial fibrillation (AF), but real-world data on its efficacy and safety in paroxysmal AF are limited. Methods: We conducted a retrospective cohort study of 247 consecutive patients with paroxysmal AF. Sinus rhythm maintenance was assessed by ECG documentation (RSR/RAS). Multivariable logistic regression analyzed predictors of treatment success, and discontinuation patterns were systematically evaluated. Results: Cordarone-treated patients had significantly higher rates of sinus rhythm maintenance compared to controls (68.8% vs 45.0%, p<0.001), with adjusted OR 3.01 (95% CI 1.72-5.27). Efficacy was greater in non-valvular AF (OR 3.45) than valvular AF (OR 1.89, p-interaction=0.038). Treatment discontinuation occurred in 27.7% of patients, primarily due to thyroid dysfunction (38.7%) and pulmonary toxicity (22.6%). Conclusion: Cordarone demonstrates superior efficacy for maintaining sinus rhythm in paroxysmal AF, particularly in non-valvular cases. However, high discontinuation rates due to toxicity necessitate careful patient selection and monitoring. Valvular AF patients may benefit from alternative therapeutic approaches.