Determinants of amiodarone use in patients with atrial fibrillation: insights from the CRAFT registry

Determinants of amiodarone use in patients with atrial fibrillation: insights from the CRAFT registry | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of amiodarone use in patients with atrial fibrillation: insights from the CRAFT registry Michał Wojewódzki, Monika Szewczak, Marta Grzesiak, Emilia Kamińska, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9181836/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract 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. Atrial fibrillation Amiodarone Heart failure Antiarrhythmic drugs Direct oral anticoagulants Registry Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and remains a major clinical challenge. The global prevalence of AF has increased by approximately 33% over the past two decades, exceeding 37.5 million affected individuals [1]. More than 90% of patients with AF experience symptoms that significantly impair their quality of life [2]. AF management aims to reduce symptoms and prevent major complications, such as stroke and heart failure. In addition to anticoagulation for thromboembolic prevention, two principal therapeutic strategies are used in the management of AF: rate control and rhythm control. Early randomized trials comparing these strategies suggested that rhythm-control did not provide a mortality benefit over rate control, although it improved exercise capacity and quality of life [3,4]. However, more recent evidence indicates that early rhythm-control therapy may reduce the risk of cardiovascular death, stroke, and heart failure progression [5]. Antiarrhythmic drugs remain the cornerstone of rhythm-control therapy. Class Ic agents (propafenone and flecainide) and class III agents (amiodarone, sotalol, and dronedarone) are most frequently used, reducing AF recurrence by approximately 50% [6,7]. Amiodarone is one of the most effective antiarrhythmic agents and is often used when other therapies are ineffective or contraindicated. particularly in patients with heart failure with reduced ejection fraction (HFrEF) or structural heart disease. Despite its high efficacy, amiodarone therapy is associated with significant limitations related to extracardiac toxicity and long-term monitoring [4,7,9,10]. Therefore, contemporary clinical guidelines recommend careful patient selection and individualized decision-making when considering amiodarone therapy. Although amiodarone remains widely used in everyday clinical practice, data describing its prescription in patients with AF are limited. The extent to which guideline recommendations influence therapeutic decisions in routine care remains unclear. This study sought to assess the use of amiodarone in contemporary clinical practice for patients with atrial fibrillation, to determine the clinical factors influencing its prescription, and to examine the alignment of treatment decisions with current guidelines, using data from the CRAFT registry. 2. Methods Study design and participants This retrospective observational study was based on data from the CRAFT registry (NCT02987062; MultiCenter expeRience in AFib patients Treated with oral anticoagulation). Initially, a registry was conducted between 2011 and 2016 in two Polish hospitals, comprising an academic center and a district hospital, with its design and baseline characteristics previously described [11–13]. Since 2017, the registry has been maintained in the district hospital’s cardiology department, and the present analysis included patients hospitalized between 2017 and 2024. The registry enrolled consecutive adult patients aged ≥ 18 years with AF, identified from the cardiology department discharge documentation. Clinical, laboratory, and treatment data were retrospectively extracted from the medical records. The study was retrospective and noninterventional in design; therefore, ethics committee approval and written informed consent were waived. Statistical analysis Statistical analyses were performed using the SPSS software (IBM Corp., Armonk, NY, USA). Continuous variables are presented as mean ± standard deviation or median (interquartile range), as appropriate, whereas categorical variables are expressed as counts and percentages. Between-group comparisons were performed using the χ² test for categorical variables and the Mann–Whitney U test for non-normally distributed continuous variables. A multivariable logistic regression analysis was performed to identify factors independently associated with amiodarone therapy. Variables with clinical relevance and those with p < 0.10 in the univariable analysis were included in the multivariable model. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). A two-sided p-value < 0.05 was considered statistically significant. Table 1 Baseline characteristics of patients receiving and not receiving amiodarone therapy Variable No amiodarone (n = 2321) Amiodarone (n = 593) p-value Demographics Age (years) 75.7 ± 10.8 71.6 ± 10.7 < 0.001 Female sex 1035 (44.6%) 255 (43.0%) 0.486 BMI (kg/m²) 28.63 ± 5.37 29.29 ± 5.65 0.024 Atrial fibrillation characteristics Paroxysmal AF 898 (38.9%) 418 (71.2%) < 0.001 Persistent AF 221 (9.6%) 142 (24.2%) Permanent AF 1187 (51.5%) 27 (4.6%) Prior electrical cardioversion 58 (11.4%) 99 (56.3%) < 0.001 Pulmonary vein isolation 81 (15.8%) 36 (20.3%) 0.168 Comorbidities Heart failure 1555 (67.5%) 427 (72.1%) 0.031 Coronary artery disease 814 (35.1%) 239 (40.3%) 0.018 Prior myocardial infarction 444 (19.2%) 145 (24.5%) 0.004 PCI history 410 (17.7%) 143 (24.2%) < 0.001 CABG history 150 (6.5%) 40 (6.8%) 0.790 Stroke/TIA history 309 (13.3%) 45 (7.6%) < 0.001 Peripheral artery disease 969 (42.6%) 193 (33.6%) < 0.001 Hyperthyroidism 152 (6.6%) 14 (2.4%) < 0.001 CIED (ICD/CRT) 915 (39.5%) 183 (30.9%) < 0.001 Laboratory and clinical variables LVEF (%) 47.3 ± 12.9 43.7 ± 14.9 < 0.001 Creatinine (mg/dL) 1.21 ± 0.55 1.31 ± 0.52 0.001 eGFR (mL/min) 53.3 ± 15.7 53.0 ± 23.8 0.028 NT-proBNP (pg/mL) 4687 ± 6568 4943 ± 7152 0.585 Hemoglobin (g/dL) 12.87 ± 1.96 13.31 ± 1.96 < 0.001 ALT (U/L) 28.8 ± 98.5 35.2 ± 48.8 0.001 AST (U/L) 29.4 ± 30.4 33.6 ± 48.1 0.518 INR 1.59 ± 0.88 1.54 ± 0.57 0.656 Pharmacotherapy DOAC therapy 1872 (80.9%) 531 (89.5%) < 0.001 VKA therapy 242 (10.5%) 25 (4.2%) < 0.001 MRA therapy 973 (42.1%) 277 (46.9%) 0.035 SGLT2 inhibitor 220 (40.3%) 101 (52.3%) 0.004 Sacubitril/valsartan 47 (8.6%) 28 (14.5%) 0.019 Values are presented as mean ± SD or n (%). AF — atrial fibrillation; CABG — coronary artery bypass grafting; PCI — percutaneous coronary intervention; CIED — cardiac implantable electronic device; DOAC — direct oral anticoagulant; VKA — vitamin K antagonist; MRA — mineralocorticoid receptor antagonist; LVEF — left ventricular ejection fraction; eGFR — estimated glomerular filtration rate. 3. Results A total of 2,914 patients with AF were enrolled in the study, including 1,290 women (44%) and 1,624 men (56%). Amiodarone therapy was administered to 593 patients (20%). Patients receiving amiodarone were younger than those not receiving this drug (71.6 vs. 75.7 years), with no significant sex-related differences. Amiodarone was most frequently used in patients with persistent AF (39.1%) and paroxysmal AF (31.8%), and was rarely used in patients with permanent AF (2.2%). A history of direct current cardioversion was strongly associated with amiodarone therapy (63.1% vs. 14.5%). Patients receiving amiodarone had slightly higher body mass index (BMI) and higher hemoglobin and alanine aminotransferase (ALT) levels, whereas aspartate transaminase (AST) levels did not differ significantly between the groups. Amiodarone therapy was more common in patients with HF, particularly in those with a lower left ventricular ejection fraction. Amiodarone use increased with worsening renal function and was associated with a lower eGFR and higher creatinine levels. Patients with coronary artery disease, prior myocardial infarction, or previous coronary angioplasty were more likely to receive amiodarone, whereas no significant differences were observed after CABG. Amiodarone therapy was less frequent in patients with implantable cardiac devices, prior stroke or TIA, peripheral artery disease, and hyperthyroidism. Amiodarone was used more frequently in patients receiving guideline-directed medical therapy for heart failure, including sacubitril/valsartan, SGLT-2 inhibitors, and mineralocorticoid receptor antagonists. No significant differences were observed for beta blockers, ACE inhibitors, ARBs, diuretics, statins, or antiplatelet therapy. Amiodarone therapy was more common in patients treated with direct oral anticoagulants than in those receiving vitamin K antagonists (22.1% vs. 9.4%, p < 0.0001). Within the DOAC group, amiodarone use was more frequent in patients receiving full-dose factor Xa inhibitors than in those receiving reduced doses. INR values were not associated with the use of amiodarone. Baseline clinical and laboratory characteristics are summarized in Table 1 . No significant differences in amiodarone therapy were observed for common AF risk factors, including hypertension, diabetes, chronic obstructive pulmonary disease, valvular disease, alcohol dependence, or smoking. Multivariable analysis Multivariable logistic regression analysis was performed with amiodarone use (yes/no) as the dependent variable to identify independent predictors of amiodarone therapy. Variables with p < 0.10 in the univariate analysis and those considered clinically relevant were included in the model. The model demonstrated good overall performance (model χ², p 0.05). No significant multicollinearity was detected, with all variables showing a variance inflation factor of less than 2. Paroxysmal or persistent atrial fibrillation was independently associated with amiodarone use (odds ratio [OR], 2.31; 95% CI 1.78–3.01; p < 0.001) and a history of prior electrical cardioversion (OR 1.89; 95% CI 1.42–2.52; p < 0.001). Younger age was also associated with a higher odds of amiodarone therapy (OR 1.27 per 10-year decrease; 95% CI 1.10–1.47; p = 0.001). The presence of HFrEF was an independent predictor of amiodarone use (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.24–2.21; p = 0.001). Treatment with direct oral anticoagulants (OR, 1.54; 95% CI, 1.18–2.01; p = 0.002) and guideline-directed medical therapy for heart failure (OR, 1.71; 95% CI, 1.29–2.27; p < 0.001) remained independently associated with amiodarone prescription (Table 2 ). Table 2 Independent predictors of amiodarone therapy in multivariable logistic regression analysis Variable Odds ratio (OR) 95% CI p-value Paroxysmal or persistent AF 2.31 1.78–3.01 < 0.001 Prior electrical cardioversion 1.89 1.42–2.52 < 0.001 Younger age (per 10-year decrease) 1.27 1.10–1.47 0.001 Heart failure (HFrEF) 1.65 1.24–2.21 0.001 Use of DOACs 1.54 1.18–2.01 0.002 Guideline-directed medical therapy (GDMT) 1.71 1.29–2.27 < 0.001 OR — odds ratio; CI — confidence interval; AF — atrial fibrillation; DOAC — direct oral anticoagulant; GDMT — guideline-directed medical therapy; HFrEF — heart failure with reduced ejection fraction. 4. Discussion This registry-based analysis provides insights into the real-world determinants of amiodarone use in patients with AF. Approximately 20% of patients in the analyzed CRAFT cohort received amiodarone, consistent with previously published registry data, including the POL-AF and EORP-AF registries [8,14]. The younger age of the patients receiving amiodarone in our study is also consistent with earlier reports [15,16]. Amiodarone therapy was predominantly utilized in patients with paroxysmal or persistent AF and infrequently used in patients with permanent AF, reflecting the role of rhythm-control therapy recommended in current ESC guidelines [10]. The strong association between amiodarone use and prior electrical cardioversion confirms the established role of this drug in facilitating the restoration and maintenance of sinus rhythm [10,18]. The lack of an association between amiodarone therapy and pulmonary vein isolation may indicate the high efficacy of catheter ablation procedures and the reduced requirement for long-term antiarrhythmic therapy following successful intervention. Patients receiving amiodarone had heart failure, coronary artery disease, prior myocardial infarction, and impaired renal function more frequently. This observation is clinically expected, as amiodarone remains the preferred antiarrhythmic drug in patients with structural heart disease and reduced left ventricular ejection fraction [10]. The ORBIT-AF and Get With The Guidelines registries have reported similar associations between amiodarone use, heart failure, and renal dysfunction [23,24]. The more frequent use of amiodarone in patients treated with guideline-directed medical therapy for HFrEF, including ARNI, MRA, and SGLT-2 inhibitors, further supports this interpretation. Interestingly, no differences in NT-proBNP concentrations were observed between the groups, despite the known relationship between atrial fibrillation, heart failure severity, and natriuretic peptide levels [19,20]. Data regarding the relationship between amiodarone therapy and natriuretic peptides are limited in the literature. Amiodarone therapy was less frequent in patients with a history of stroke or TIA and those with higher CHA₂DS₂-VA scores. This may reflect a more cautious therapeutic approach in patients with multimorbidity and a high thromboembolic risk [23]. Although rhythm-control may reduce cardiovascular complications, careful risk–benefit assessment is required in this population [5]. The present study also demonstrated an association between amiodarone therapy and the use of direct oral anticoagulants, whereas concomitant vitamin K antagonist therapy was less common. This likely reflects contemporary anticoagulation practice patterns and guideline recommendations favoring DOAC therapy in AF [10]. Similar findings have been reported in other observational studies [29]. The use of amiodarone more frequently in patients taking full-dose factor Xa inhibitors may suggest that these patients are clinically more stable, whereas there is no association with dabigatran therapy, possibly due to concerns about drug interactions and the risk of bleeding [22]. Amiodarone use was found to be unrelated to typical cardiovascular risk factors, including hypertension, diabetes, chronic obstructive pulmonary disease, smoking, or excessive alcohol consumption, in line with previous findings [16]. These results suggest that decisions regarding antiarrhythmic therapy are primarily driven by arrhythmia characteristics, structural heart disease, and prior rhythm-control interventions, rather than traditional cardiovascular risk factors. The increased use of amiodarone was linked to impaired renal function, a correlation that is consistent with pharmacological principles, as amiodarone does not require dose adjustment in chronic kidney disease, whereas other antiarrhythmic drugs may need to be modified or are contraindicated [23,25]. Similarly, the less frequent use of amiodarone in patients with hyperthyroidism reflects an awareness of this drug’s well-established thyroid toxicity [26,27]. The lower use of amiodarone in patients with implanted cardiac devices may be related to the antiarrhythmic effects of pacing therapy and improved hemodynamics [28–30]. Overall, the observed prescription patterns are largely consistent with current European Society of Cardiology guidelines and findings from previously published atrial fibrillation registries [10,14,15,17,23,24]. Despite the increasing use of catheter ablation and newer therapeutic strategies, amiodarone continues to play an important role in rhythm-control therapy in selected patients with AF. 4.1 Limitations This study has several limitations. First, because of its retrospective and observational design, causal relationships between clinical factors and amiodarone use cannot be established. Second, the analyzed cohort included only patients hospitalized in the cardiology department, which may limit the generalizability of the findings to outpatient populations or patients treated in other clinical settings. Third, patients were included at different stages of amiodarone therapy, and in some cases, the drug may have been prescribed for indications other than rhythm-control in atrial fibrillation, potentially influencing the observed associations. Finally, the registry excluded detailed data on treatment duration, amiodarone adverse effects, or long-term clinical outcomes. 5. Conclusion Amiodarone therapy was used in approximately 20% of patients in this real-world registry of patients with atrial fibrillation, primarily in association with rhythm control strategy, structural heart disease, heart failure, and impaired renal function. The observed prescribing patterns were largely consistent with contemporary guideline recommendations and reflected clinical decision-making in patients with limited antiarrhythmic options. These findings provide insights into the role of amiodarone in the contemporary management of atrial fibrillation. Abbreviations AF — atrial fibrillation ALT — alanine aminotransferase ARNI — angiotensin receptor–neprilysin inhibitor AST — aspartate aminotransferase BMI — body mass index CABG — coronary artery bypass grafting CAD — coronary artery disease CI — confidence interval CIED — cardiac implantable electronic device COPD — chronic obstructive pulmonary disease CRAFT — MultiCenter expeRience in AFib patients Treated with oral anticoagulation DCC — direct current cardioversion DOAC — direct oral anticoagulant eGFR — estimated glomerular filtration rate ESC — European Society of Cardiology GDMT — guideline-directed medical therapy HF — heart failure HFrEF — heart failure with reduced ejection fraction INR — international normalized ratio LVEF — left ventricular ejection fraction MI — myocardial infarction MRA — mineralocorticoid receptor antagonist NT-proBNP — N-terminal pro–B-type natriuretic peptide OR — odds ratio PAD — peripheral artery disease PCI — percutaneous coronary intervention SGLT2i — sodium–glucose cotransporter-2 inhibitor TIA — transient ischemic attack VKA — vitamin K antagonists Declarations Ethics approval and consent to participate Due to the study's retrospective, non-interventional design, the local ethics committee waived the requirement for written informed consent. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare no competing interests. Funding No specific funding was received for this study. Authors' contributions MW and JB conceived and designed the study. MW performed the statistical analysis and drafted the manuscript. MS, MG, EK, MK, and KW collected the data. JB supervised the study and critically revised the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors thank Dr. Hab. inż. Mariusz Topolski (Wroclaw University of Science and Technology) for statistical consultation. References Lip GY, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217–221. Schnabel RB, Pecen L, Ojeda FM, Lucerna M, Rzayeva N, Blankenberg S, et al. Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation. Heart. 2017;103(13):1024–1030. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–1833. Istratoaie S, Sabin O, Vesa SC, Cismaru G, Donca VI, Buzoianu AD. Efficacy of amiodarone for the prevention of atrial fibrillation recurrence after cardioversion. Cardiovasc J Afr. 2021;32(6):327–338. Camm AJ, Naccarelli GV, Mittal S, Crijns HJGM, Hohnloser SH, Ma CS, et al. The increasing role of rhythm control in patients with atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(19):1932–1948. Allen LaPointe NM, Lokhnygina Y, Sanders GD, Peterson ED, Al-Khatib SM. Adherence to guideline recommendations for antiarrhythmic drugs in atrial fibrillation. Am Heart J. 2013;166(5):871–878. Valembois L, Audureau E, Takeda A, Jarzebowski W, Belmin J, Lafuente-Lafuente C. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2019;(9). Lip GY, Laroche C, Dan GA, Santini M, Kalarus Z, Rasmussen LH, et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of the EORP-AF pilot general registry. Europace. 2014;16(3):308–319. Hamilton D, Nandkeolyar S, Lan H, Desai P, Evans J, Hauschild C, et al. Amiodarone: a comprehensive guide for clinicians. Am J Cardiovasc Drugs. 2020;20(6):549–558. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns H, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2024;45(36):3314–3414. Bednarski J, Balsam P, Tymińska A, Ozierański K, Żukowska K, Zaleska M, et al. District versus academic hospitals: differences in clinical characteristics of patients with atrial fibrillation without valvular heart disease treated with oral anticoagulants. Pol Arch Intern Med. 2018;128(5):274–279. Balsam P, Lodziński P, Gawałko M, Kraj L, Śliwczyński A, Maciejewski C, et al. Antithrombotic management and long-term outcomes of patients with atrial fibrillation: insights from the CRAFT trial. J Clin Med. 2021;10(8). Lodziński P, Gawałko M, Kraj L, Śliwczyński A, Maciejewski C, Krzowski B, et al. District versus academic hospitals: clinical outcomes of patients with atrial fibrillation. Pol Arch Intern Med. 2021;131(10). Gawałko M, Budnik M, Gorczyca I, Jelonek O, Uziębło-Życzkowska B, Maciorowska M, et al. Characteristics and treatment of atrial fibrillation with respect to the presence or absence of heart failure: insights from the POL-AF registry. J Clin Med. 2021;10(7). Hou XX, He L, Du X, Wang GH, Dong JZ, Ma CS. Association between use of amiodarone for non-valvular atrial fibrillation and patient survival: China atrial fibrillation registry. Chin Med J (Engl). 2020;134(3):309–317. Shurrab M, Koh M, Jackevicius CA, Qiu F, Conlon M, Caswell J, et al. Prescribing of two potentially interacting cardiovascular medications in atrial fibrillation patients on direct oral anticoagulants. Int J Cardiol Heart Vasc. 2021;34:100788. Steinberg BA, Hellkamp AS, Lokhnygina Y, Halperin JL, Breithardt G, Passman R, et al. Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: ROCKET AF trial. Heart Rhythm. 2014;11(6):925–932. Um KJ, McIntyre WF, Healey JS, Mendoza PA, Koziarz A, Amit G, et al. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: systematic review and meta-analysis. Europace. 2019;21(6):856–863. Jug B, Sebestjen M, Sabovic M, Pohar M, Keber I. Atrial fibrillation is an independent determinant of increased NT-proBNP levels in outpatients with signs and symptoms of heart failure. Wien Klin Wochenschr. 2009;121(21–22):700–706. Darkner S, Goetze JP, Chen X, Henningsen K, Pehrson S, Svendsen JH. Natriuretic propeptides as markers of atrial fibrillation burden and recurrence (AMIO-CAT trial). Am J Cardiol. 2017;120(8):1309–1315. Dong C, Wang K, Di Tullio MR, Gutierrez C, Koch S, García EJ, et al. Disparities and temporal trends in stroke care outcomes in patients with atrial fibrillation. Int J Cerebrovasc Dis Stroke. 2019;2(1). Wu VC, Wang CL, Huang YC, Tu HT, Huang YT, Kuo CF, et al. Bleeding associated with antiarrhythmic drugs in patients with atrial fibrillation using direct oral anticoagulants. J Am Heart Assoc. 2024;13(21):e033513. Washam JB, Holmes DN, Thomas LE, Pokorney SD, Hylek EM, Fonarow GC, et al. Pharmacotherapy for atrial fibrillation in patients with chronic kidney disease: insights from ORBIT-AF. J Am Heart Assoc. 2018;7(18):e008928. Desai NR, Sciria CT, Zhao X, Piccini JP, Turakhia MP, Matsouaka R, et al. Patterns of care for atrial fibrillation before, during, and at discharge from hospitalization: Get With The Guidelines-AF registry. Circ Arrhythm Electrophysiol. 2021;14(4):e009003. Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: meta-analysis. Eur Heart J. 2014;35(7):455–469. Rahimi-Bashar F, Vahedian-Azimi A, Dalvand S, Karimi L, Moshkani M, Alimohamadi Y, et al. Prevalence of amiodarone-induced thyroid dysfunction: systematic review and meta-analysis. Curr Med Chem. 2023;30(23):2690–2699. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism. Thyroid. 2016;26(10):1343–1421. Knight BP, Gersh BJ, Carlson MD, Friedman PA, McNamara RL, Strickberger SA, et al. Role of permanent pacing to prevent atrial fibrillation. Circulation. 2005;111(2):240–243. Inoue N, Ishikawa T, Sumita S, Kobayashi T, Matsushita K, Matsumoto K, et al. Suppression of atrial fibrillation by atrial pacing. Circ J. 2006;70(11):1398–1401. Brenyo A, Link MS, Barsheshet A, Moss AJ, Zareba W, Wang PJ, et al. Cardiac resynchronization therapy reduces left atrial volume and atrial tachyarrhythmias in MADIT-CRT. J Am Coll Cardiol. 2011;58(16):1682–1689. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9181836","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630353875,"identity":"5f27a4af-7f98-4523-8eec-ff9d4b9a663c","order_by":0,"name":"Michał Wojewódzki","email":"","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michał","middleName":"","lastName":"Wojewódzki","suffix":""},{"id":630353876,"identity":"b5ddb1ce-4223-46ca-a08d-7d466b8e7ff4","order_by":1,"name":"Monika Szewczak","email":"","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":false,"prefix":"","firstName":"Monika","middleName":"","lastName":"Szewczak","suffix":""},{"id":630353879,"identity":"5ec55e4b-53c7-47d2-b3e3-c561f34825c1","order_by":2,"name":"Marta Grzesiak","email":"","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"","lastName":"Grzesiak","suffix":""},{"id":630353883,"identity":"04ba3d9c-bcfa-4b08-b5b5-c6fec0d55066","order_by":3,"name":"Emilia Kamińska","email":"","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":false,"prefix":"","firstName":"Emilia","middleName":"","lastName":"Kamińska","suffix":""},{"id":630353885,"identity":"49d02675-3b5f-4a94-a7a6-28cdddaeaf3f","order_by":4,"name":"Maciej Karczewski","email":"","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":false,"prefix":"","firstName":"Maciej","middleName":"","lastName":"Karczewski","suffix":""},{"id":630353889,"identity":"4c05f2d2-8681-4bbb-a715-77d824136d31","order_by":5,"name":"Karolina Własiuk","email":"","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":false,"prefix":"","firstName":"Karolina","middleName":"","lastName":"Własiuk","suffix":""},{"id":630353891,"identity":"d97845e4-c228-4a9e-9e66-33afa07e71d6","order_by":6,"name":"Janusz Bednarski","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAmElEQVRIiWNgGAWjYHACMwYGNhsQg/EAKVrSwCyStBwmQYtue/O2Bx/KziduZ+A9QJwWszPHyg1nnLuduLOBL4FILTdyzKR5227nbjjAY0CklvtvzKT/tp0jRcsNHjNpxrYDpGg5k1Zu2HMuuX5nM9F+OX5424MfZXbG5uy9Bx8QpQUODJh5SNMA1MJAspZRMApGwSgYKQAAQRE1ZrWFwooAAAAASUVORK5CYII=","orcid":"","institution":"St. John Paul II Western Hospital","correspondingAuthor":true,"prefix":"","firstName":"Janusz","middleName":"","lastName":"Bednarski","suffix":""}],"badges":[],"createdAt":"2026-03-20 20:23:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9181836/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9181836/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108401573,"identity":"68a096fb-23bb-4e0c-ad28-ae722445c816","added_by":"auto","created_at":"2026-05-04 09:06:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47479,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical and pharmacological factors significantly associated with amiodarone therapy.\u003c/strong\u003e\u003cbr\u003e\nYES/NO refers to the presence of a given factor or the use of a particular drug. Percentage values represent the proportion of patients treated with amiodarone.\u003cbr\u003e\nHF — heart failure; CAD — coronary artery disease; MI — myocardial infarction; PCI — percutaneous coronary intervention; PAD — peripheral artery disease; CIED — cardiac implantable electronic device; DCC — direct current cardioversion; ARNI — angiotensin receptor–neprilysin inhibitor; MRA — mineralocorticoid receptor antagonist; SGLT2i — sodium–glucose cotransporter-2 inhibitor.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9181836/v1/35a27e5fcc19c95b48b9d429.png"},{"id":108401574,"identity":"8cd08aee-a0c3-436a-ae39-be5ed7decbd5","added_by":"auto","created_at":"2026-05-04 09:06:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":47426,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency of amiodarone use depending on the type of anticoagulant therapy.\u003c/strong\u003e\u003cbr\u003e\nBars represent the proportion of patients treated with amiodarone in each anticoagulant group. Differences between groups were statistically significant.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9181836/v1/1b8203d651d039a64cdd9a50.png"},{"id":108401575,"identity":"044f85e3-db8f-491e-a4c1-3ef82641e811","added_by":"auto","created_at":"2026-05-04 09:06:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":46437,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAmiodarone use according to atrial fibrillation type.\u003c/strong\u003e\u003cbr\u003e\nDistribution of amiodarone therapy across paroxysmal, persistent, and permanent atrial fibrillation.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9181836/v1/09d3ddde2af9f7abf74628ce.png"},{"id":108401576,"identity":"b9abd3ae-5b66-4989-8529-be12380d3790","added_by":"auto","created_at":"2026-05-04 09:06:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":36974,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot showing independent predictors of amiodarone therapy identified in multivariable logistic regression analysis. Data are presented as odds ratios (ORs) with 95% confidence intervals (CIs). The vertical line at OR = 1 denotes no effect. Variables included in the model were selected based on clinical relevance and univariable analysis. Corresponding ORs, 95% CIs, and p-values are displayed on the right\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9181836/v1/216a753a34d44102b372a153.png"},{"id":108493131,"identity":"024b724a-9267-43a6-a9ae-e8ce435cf32b","added_by":"auto","created_at":"2026-05-05 09:59:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":424538,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9181836/v1/d02444a6-8542-4df9-ba25-e9454ed99b0f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of amiodarone use in patients with atrial fibrillation: insights from the CRAFT registry","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and remains a major clinical challenge. The global prevalence of AF has increased by approximately 33% over the past two decades, exceeding 37.5\u0026nbsp;million affected individuals [1]. More than 90% of patients with AF experience symptoms that significantly impair their quality of life [2]. AF management aims to reduce symptoms and prevent major complications, such as stroke and heart failure.\u003c/p\u003e \u003cp\u003eIn addition to anticoagulation for thromboembolic prevention, two principal therapeutic strategies are used in the management of AF: rate control and rhythm control. Early randomized trials comparing these strategies suggested that rhythm-control did not provide a mortality benefit over rate control, although it improved exercise capacity and quality of life [3,4]. However, more recent evidence indicates that early rhythm-control therapy may reduce the risk of cardiovascular death, stroke, and heart failure progression [5].\u003c/p\u003e \u003cp\u003eAntiarrhythmic drugs remain the cornerstone of rhythm-control therapy. Class Ic agents (propafenone and flecainide) and class III agents (amiodarone, sotalol, and dronedarone) are most frequently used, reducing AF recurrence by approximately 50% [6,7]. Amiodarone is one of the most effective antiarrhythmic agents and is often used when other therapies are ineffective or contraindicated. particularly in patients with heart failure with reduced ejection fraction (HFrEF) or structural heart disease.\u003c/p\u003e \u003cp\u003eDespite its high efficacy, amiodarone therapy is associated with significant limitations related to extracardiac toxicity and long-term monitoring [4,7,9,10]. Therefore, contemporary clinical guidelines recommend careful patient selection and individualized decision-making when considering amiodarone therapy.\u003c/p\u003e \u003cp\u003eAlthough amiodarone remains widely used in everyday clinical practice, data describing its prescription in patients with AF are limited. The extent to which guideline recommendations influence therapeutic decisions in routine care remains unclear.\u003c/p\u003e \u003cp\u003e This study sought to assess the use of amiodarone in contemporary clinical practice for patients with atrial fibrillation, to determine the clinical factors influencing its prescription, and to examine the alignment of treatment decisions with current guidelines, using data from the CRAFT registry.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cb\u003eStudy design and participants\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis retrospective observational study was based on data from the CRAFT registry (NCT02987062; MultiCenter expeRience in AFib patients Treated with oral anticoagulation). Initially, a registry was conducted between 2011 and 2016 in two Polish hospitals, comprising an academic center and a district hospital, with its design and baseline characteristics previously described [11\u0026ndash;13].\u003c/p\u003e \u003cp\u003eSince 2017, the registry has been maintained in the district hospital\u0026rsquo;s cardiology department, and the present analysis included patients hospitalized between 2017 and 2024.\u003c/p\u003e \u003cp\u003eThe registry enrolled consecutive adult patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years with AF, identified from the cardiology department discharge documentation. Clinical, laboratory, and treatment data were retrospectively extracted from the medical records.\u003c/p\u003e \u003cp\u003e The study was retrospective and noninterventional in design; therefore, ethics committee approval and written informed consent were waived.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eStatistical analyses were performed using the SPSS software (IBM Corp., Armonk, NY, USA). Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range), as appropriate, whereas categorical variables are expressed as counts and percentages.\u003c/p\u003e \u003cp\u003eBetween-group comparisons were performed using the χ\u0026sup2; test for categorical variables and the Mann\u0026ndash;Whitney U test for non-normally distributed continuous variables.\u003c/p\u003e \u003cp\u003eA multivariable logistic regression analysis was performed to identify factors independently associated with amiodarone therapy. Variables with clinical relevance and those with p\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in the univariable analysis were included in the multivariable model.\u003c/p\u003e \u003cp\u003eResults are presented as odds ratios (OR) with 95% confidence intervals (CI). A two-sided p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients receiving and not receiving amiodarone therapy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo amiodarone (n\u0026thinsp;=\u0026thinsp;2321)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmiodarone (n\u0026thinsp;=\u0026thinsp;593)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1035 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (43.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.29\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrial fibrillation characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParoxysmal AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e898 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e418 (71.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersistent AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1187 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior electrical cardioversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary vein isolation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1555 (67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e427 (72.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e814 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior myocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e444 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCI history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e410 (17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCABG history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke/TIA history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e309 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e969 (42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperthyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIED (ICD/CRT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e915 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory and clinical variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR (mL/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNT-proBNP (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4687\u0026thinsp;\u0026plusmn;\u0026thinsp;6568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4943\u0026thinsp;\u0026plusmn;\u0026thinsp;7152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;98.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;48.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4\u0026thinsp;\u0026plusmn;\u0026thinsp;30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.6\u0026thinsp;\u0026plusmn;\u0026thinsp;48.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePharmacotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDOAC therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1872 (80.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e531 (89.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVKA therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e242 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRA therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e973 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGLT2 inhibitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSacubitril/valsartan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%). AF \u0026mdash; atrial fibrillation; CABG \u0026mdash; coronary artery bypass grafting; PCI \u0026mdash; percutaneous coronary intervention; CIED \u0026mdash; cardiac implantable electronic device; DOAC \u0026mdash; direct oral anticoagulant; VKA \u0026mdash; vitamin K antagonist; MRA \u0026mdash; mineralocorticoid receptor antagonist; LVEF \u0026mdash; left ventricular ejection fraction; eGFR \u0026mdash; estimated glomerular filtration rate.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 2,914 patients with AF were enrolled in the study, including 1,290 women (44%) and 1,624 men (56%). Amiodarone therapy was administered to 593 patients (20%).\u003c/p\u003e \u003cp\u003ePatients receiving amiodarone were younger than those not receiving this drug (71.6 vs. 75.7 years), with no significant sex-related differences. Amiodarone was most frequently used in patients with persistent AF (39.1%) and paroxysmal AF (31.8%), and was rarely used in patients with permanent AF (2.2%). A history of direct current cardioversion was strongly associated with amiodarone therapy (63.1% vs. 14.5%).\u003c/p\u003e \u003cp\u003ePatients receiving amiodarone had slightly higher body mass index (BMI) and higher hemoglobin and alanine aminotransferase (ALT) levels, whereas aspartate transaminase (AST) levels did not differ significantly between the groups. Amiodarone therapy was more common in patients with HF, particularly in those with a lower left ventricular ejection fraction. Amiodarone use increased with worsening renal function and was associated with a lower eGFR and higher creatinine levels.\u003c/p\u003e \u003cp\u003ePatients with coronary artery disease, prior myocardial infarction, or previous coronary angioplasty were more likely to receive amiodarone, whereas no significant differences were observed after CABG. Amiodarone therapy was less frequent in patients with implantable cardiac devices, prior stroke or TIA, peripheral artery disease, and hyperthyroidism.\u003c/p\u003e \u003cp\u003e Amiodarone was used more frequently in patients receiving guideline-directed medical therapy for heart failure, including sacubitril/valsartan, SGLT-2 inhibitors, and mineralocorticoid receptor antagonists. No significant differences were observed for beta blockers, ACE inhibitors, ARBs, diuretics, statins, or antiplatelet therapy.\u003c/p\u003e \u003cp\u003eAmiodarone therapy was more common in patients treated with direct oral anticoagulants than in those receiving vitamin K antagonists (22.1% vs. 9.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Within the DOAC group, amiodarone use was more frequent in patients receiving full-dose factor Xa inhibitors than in those receiving reduced doses. INR values were not associated with the use of amiodarone. Baseline clinical and laboratory characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eNo significant differences in amiodarone therapy were observed for common AF risk factors, including hypertension, diabetes, chronic obstructive pulmonary disease, valvular disease, alcohol dependence, or smoking.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMultivariable analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMultivariable logistic regression analysis was performed with amiodarone use (yes/no) as the dependent variable to identify independent predictors of amiodarone therapy. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in the univariate analysis and those considered clinically relevant were included in the model. The model demonstrated good overall performance (model χ\u0026sup2;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and acceptable calibration (Hosmer\u0026ndash;Lemeshow test, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). No significant multicollinearity was detected, with all variables showing a variance inflation factor of less than 2.\u003c/p\u003e \u003cp\u003eParoxysmal or persistent atrial fibrillation was independently associated with amiodarone use (odds ratio [OR], 2.31; 95% CI 1.78\u0026ndash;3.01; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a history of prior electrical cardioversion (OR 1.89; 95% CI 1.42\u0026ndash;2.52; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Younger age was also associated with a higher odds of amiodarone therapy (OR 1.27 per 10-year decrease; 95% CI 1.10\u0026ndash;1.47; p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe presence of HFrEF was an independent predictor of amiodarone use (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.24\u0026ndash;2.21; p\u0026thinsp;=\u0026thinsp;0.001). Treatment with direct oral anticoagulants (OR, 1.54; 95% CI, 1.18\u0026ndash;2.01; p\u0026thinsp;=\u0026thinsp;0.002) and guideline-directed medical therapy for heart failure (OR, 1.71; 95% CI, 1.29\u0026ndash;2.27; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) remained independently associated with amiodarone prescription (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndependent predictors of amiodarone therapy in multivariable logistic regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio (OR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParoxysmal or persistent AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.78\u0026ndash;3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior electrical cardioversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026ndash;2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYounger age (per 10-year decrease)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.10\u0026ndash;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure (HFrEF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.24\u0026ndash;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of DOACs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.18\u0026ndash;2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuideline-directed medical therapy (GDMT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29\u0026ndash;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e OR \u0026mdash; odds ratio; CI \u0026mdash; confidence interval; AF \u0026mdash; atrial fibrillation; DOAC \u0026mdash; direct oral anticoagulant; GDMT \u0026mdash; guideline-directed medical therapy; HFrEF \u0026mdash; heart failure with reduced ejection fraction.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis registry-based analysis provides insights into the real-world determinants of amiodarone use in patients with AF. Approximately 20% of patients in the analyzed CRAFT cohort received amiodarone, consistent with previously published registry data, including the POL-AF and EORP-AF registries [8,14]. The younger age of the patients receiving amiodarone in our study is also consistent with earlier reports [15,16].\u003c/p\u003e \u003cp\u003e Amiodarone therapy was predominantly utilized in patients with paroxysmal or persistent AF and infrequently used in patients with permanent AF, reflecting the role of rhythm-control therapy recommended in current ESC guidelines [10]. The strong association between amiodarone use and prior electrical cardioversion confirms the established role of this drug in facilitating the restoration and maintenance of sinus rhythm [10,18]. The lack of an association between amiodarone therapy and pulmonary vein isolation may indicate the high efficacy of catheter ablation procedures and the reduced requirement for long-term antiarrhythmic therapy following successful intervention.\u003c/p\u003e \u003cp\u003ePatients receiving amiodarone had heart failure, coronary artery disease, prior myocardial infarction, and impaired renal function more frequently. This observation is clinically expected, as amiodarone remains the preferred antiarrhythmic drug in patients with structural heart disease and reduced left ventricular ejection fraction [10]. The ORBIT-AF and Get With The Guidelines registries have reported similar associations between amiodarone use, heart failure, and renal dysfunction [23,24]. The more frequent use of amiodarone in patients treated with guideline-directed medical therapy for HFrEF, including ARNI, MRA, and SGLT-2 inhibitors, further supports this interpretation.\u003c/p\u003e \u003cp\u003eInterestingly, no differences in NT-proBNP concentrations were observed between the groups, despite the known relationship between atrial fibrillation, heart failure severity, and natriuretic peptide levels [19,20]. Data regarding the relationship between amiodarone therapy and natriuretic peptides are limited in the literature.\u003c/p\u003e \u003cp\u003eAmiodarone therapy was less frequent in patients with a history of stroke or TIA and those with higher CHA₂DS₂-VA scores. This may reflect a more cautious therapeutic approach in patients with multimorbidity and a high thromboembolic risk [23]. Although rhythm-control may reduce cardiovascular complications, careful risk\u0026ndash;benefit assessment is required in this population [5].\u003c/p\u003e \u003cp\u003eThe present study also demonstrated an association between amiodarone therapy and the use of direct oral anticoagulants, whereas concomitant vitamin K antagonist therapy was less common. This likely reflects contemporary anticoagulation practice patterns and guideline recommendations favoring DOAC therapy in AF [10]. Similar findings have been reported in other observational studies [29]. The use of amiodarone more frequently in patients taking full-dose factor Xa inhibitors may suggest that these patients are clinically more stable, whereas there is no association with dabigatran therapy, possibly due to concerns about drug interactions and the risk of bleeding [22].\u003c/p\u003e \u003cp\u003eAmiodarone use was found to be unrelated to typical cardiovascular risk factors, including hypertension, diabetes, chronic obstructive pulmonary disease, smoking, or excessive alcohol consumption, in line with previous findings [16]. These results suggest that decisions regarding antiarrhythmic therapy are primarily driven by arrhythmia characteristics, structural heart disease, and prior rhythm-control interventions, rather than traditional cardiovascular risk factors.\u003c/p\u003e \u003cp\u003eThe increased use of amiodarone was linked to impaired renal function, a correlation that is consistent with pharmacological principles, as amiodarone does not require dose adjustment in chronic kidney disease, whereas other antiarrhythmic drugs may need to be modified or are contraindicated [23,25]. Similarly, the less frequent use of amiodarone in patients with hyperthyroidism reflects an awareness of this drug\u0026rsquo;s well-established thyroid toxicity [26,27].\u003c/p\u003e \u003cp\u003eThe lower use of amiodarone in patients with implanted cardiac devices may be related to the antiarrhythmic effects of pacing therapy and improved hemodynamics [28\u0026ndash;30].\u003c/p\u003e \u003cp\u003e Overall, the observed prescription patterns are largely consistent with current European Society of Cardiology guidelines and findings from previously published atrial fibrillation registries [10,14,15,17,23,24].\u003c/p\u003e \u003cp\u003eDespite the increasing use of catheter ablation and newer therapeutic strategies, amiodarone continues to play an important role in rhythm-control therapy in selected patients with AF.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, because of its retrospective and observational design, causal relationships between clinical factors and amiodarone use cannot be established. Second, the analyzed cohort included only patients hospitalized in the cardiology department, which may limit the generalizability of the findings to outpatient populations or patients treated in other clinical settings. Third, patients were included at different stages of amiodarone therapy, and in some cases, the drug may have been prescribed for indications other than rhythm-control in atrial fibrillation, potentially influencing the observed associations. Finally, the registry excluded detailed data on treatment duration, amiodarone adverse effects, or long-term clinical outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eAmiodarone therapy was used in approximately 20% of patients in this real-world registry of patients with atrial fibrillation, primarily in association with rhythm control strategy, structural heart disease, heart failure, and impaired renal function. The observed prescribing patterns were largely consistent with contemporary guideline recommendations and reflected clinical decision-making in patients with limited antiarrhythmic options. These findings provide insights into the role of amiodarone in the contemporary management of atrial fibrillation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAF \u0026mdash; atrial fibrillation\u003cbr\u003e\u0026nbsp;ALT \u0026mdash; alanine aminotransferase\u003cbr\u003e\u0026nbsp;ARNI \u0026mdash; angiotensin receptor\u0026ndash;neprilysin inhibitor\u003cbr\u003e\u0026nbsp;AST \u0026mdash; aspartate aminotransferase\u003cbr\u003e\u0026nbsp;BMI \u0026mdash; body mass index\u003cbr\u003e\u0026nbsp;CABG \u0026mdash; coronary artery bypass grafting\u003cbr\u003e\u0026nbsp;CAD \u0026mdash; coronary artery disease\u003cbr\u003e\u0026nbsp;CI \u0026mdash; confidence interval\u003cbr\u003e\u0026nbsp;CIED \u0026mdash; cardiac implantable electronic device\u003cbr\u003e\u0026nbsp;COPD \u0026mdash; chronic obstructive pulmonary disease\u003cbr\u003e\u0026nbsp;CRAFT \u0026mdash; MultiCenter expeRience in AFib patients Treated with oral anticoagulation\u003cbr\u003e\u0026nbsp;DCC \u0026mdash; direct current cardioversion\u003cbr\u003e\u0026nbsp;DOAC \u0026mdash; direct oral anticoagulant\u003cbr\u003e\u0026nbsp;eGFR \u0026mdash; estimated glomerular filtration rate\u003cbr\u003e\u0026nbsp;ESC \u0026mdash; European Society of Cardiology\u003cbr\u003e\u0026nbsp;GDMT \u0026mdash; guideline-directed medical therapy\u003cbr\u003e\u0026nbsp;HF \u0026mdash; heart failure\u003cbr\u003e\u0026nbsp;HFrEF \u0026mdash; heart failure with reduced ejection fraction\u003cbr\u003e\u0026nbsp;INR \u0026mdash; international normalized ratio\u003cbr\u003e\u0026nbsp;LVEF \u0026mdash; left ventricular ejection fraction\u003cbr\u003e\u0026nbsp;MI \u0026mdash; myocardial infarction\u003cbr\u003e\u0026nbsp;MRA \u0026mdash; mineralocorticoid receptor antagonist\u003cbr\u003e\u0026nbsp;NT-proBNP \u0026mdash; N-terminal pro\u0026ndash;B-type natriuretic peptide\u003cbr\u003e\u0026nbsp;OR \u0026mdash; odds ratio\u003cbr\u003e\u0026nbsp;PAD \u0026mdash; peripheral artery disease\u003cbr\u003e\u0026nbsp;PCI \u0026mdash; percutaneous coronary intervention\u003cbr\u003e\u0026nbsp;SGLT2i \u0026mdash; sodium\u0026ndash;glucose cotransporter-2 inhibitor\u003cbr\u003e\u0026nbsp;TIA \u0026mdash; transient ischemic attack\u003cbr\u003e\u0026nbsp;VKA \u0026mdash; vitamin K antagonists\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the study\u0026apos;s retrospective, non-interventional design, the local ethics committee waived the requirement for written informed consent. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMW and JB conceived and designed the study.\u003cbr\u003e\u0026nbsp;MW performed the statistical analysis and drafted the manuscript.\u003cbr\u003e\u0026nbsp;MS, MG, EK, MK, and KW collected the data.\u003cbr\u003e\u0026nbsp;JB supervised the study and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Dr. Hab. inż. Mariusz Topolski (Wroclaw University of Science and Technology) for statistical consultation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLip GY, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217\u0026ndash;221.\u003c/li\u003e\n\u003cli\u003eSchnabel RB, Pecen L, Ojeda FM, Lucerna M, Rzayeva N, Blankenberg S, et al. Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation. Heart. 2017;103(13):1024\u0026ndash;1030.\u003c/li\u003e\n\u003cli\u003eWyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825\u0026ndash;1833.\u003c/li\u003e\n\u003cli\u003eIstratoaie S, Sabin O, Vesa SC, Cismaru G, Donca VI, Buzoianu AD. Efficacy of amiodarone for the prevention of atrial fibrillation recurrence after cardioversion. Cardiovasc J Afr. 2021;32(6):327\u0026ndash;338.\u003c/li\u003e\n\u003cli\u003eCamm AJ, Naccarelli GV, Mittal S, Crijns HJGM, Hohnloser SH, Ma CS, et al. The increasing role of rhythm control in patients with atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(19):1932\u0026ndash;1948.\u003c/li\u003e\n\u003cli\u003eAllen LaPointe NM, Lokhnygina Y, Sanders GD, Peterson ED, Al-Khatib SM. Adherence to guideline recommendations for antiarrhythmic drugs in atrial fibrillation. Am Heart J. 2013;166(5):871\u0026ndash;878.\u003c/li\u003e\n\u003cli\u003eValembois L, Audureau E, Takeda A, Jarzebowski W, Belmin J, Lafuente-Lafuente C. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2019;(9).\u003c/li\u003e\n\u003cli\u003eLip GY, Laroche C, Dan GA, Santini M, Kalarus Z, Rasmussen LH, et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of the EORP-AF pilot general registry. Europace. 2014;16(3):308\u0026ndash;319.\u003c/li\u003e\n\u003cli\u003eHamilton D, Nandkeolyar S, Lan H, Desai P, Evans J, Hauschild C, et al. Amiodarone: a comprehensive guide for clinicians. Am J Cardiovasc Drugs. 2020;20(6):549\u0026ndash;558.\u003c/li\u003e\n\u003cli\u003eVan Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns H, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2024;45(36):3314\u0026ndash;3414.\u003c/li\u003e\n\u003cli\u003eBednarski J, Balsam P, Tymińska A, Ozierański K, Żukowska K, Zaleska M, et al. District versus academic hospitals: differences in clinical characteristics of patients with atrial fibrillation without valvular heart disease treated with oral anticoagulants. Pol Arch Intern Med. 2018;128(5):274\u0026ndash;279.\u003c/li\u003e\n\u003cli\u003eBalsam P, Lodziński P, Gawałko M, Kraj L, Śliwczyński A, Maciejewski C, et al. Antithrombotic management and long-term outcomes of patients with atrial fibrillation: insights from the CRAFT trial. J Clin Med. 2021;10(8).\u003c/li\u003e\n\u003cli\u003eLodziński P, Gawałko M, Kraj L, Śliwczyński A, Maciejewski C, Krzowski B, et al. District versus academic hospitals: clinical outcomes of patients with atrial fibrillation. Pol Arch Intern Med. 2021;131(10).\u003c/li\u003e\n\u003cli\u003eGawałko M, Budnik M, Gorczyca I, Jelonek O, Uziębło-Życzkowska B, Maciorowska M, et al. Characteristics and treatment of atrial fibrillation with respect to the presence or absence of heart failure: insights from the POL-AF registry. J Clin Med. 2021;10(7).\u003c/li\u003e\n\u003cli\u003eHou XX, He L, Du X, Wang GH, Dong JZ, Ma CS. Association between use of amiodarone for non-valvular atrial fibrillation and patient survival: China atrial fibrillation registry. Chin Med J (Engl). 2020;134(3):309\u0026ndash;317.\u003c/li\u003e\n\u003cli\u003eShurrab M, Koh M, Jackevicius CA, Qiu F, Conlon M, Caswell J, et al. Prescribing of two potentially interacting cardiovascular medications in atrial fibrillation patients on direct oral anticoagulants. Int J Cardiol Heart Vasc. 2021;34:100788.\u003c/li\u003e\n\u003cli\u003eSteinberg BA, Hellkamp AS, Lokhnygina Y, Halperin JL, Breithardt G, Passman R, et al. Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: ROCKET AF trial. Heart Rhythm. 2014;11(6):925\u0026ndash;932.\u003c/li\u003e\n\u003cli\u003eUm KJ, McIntyre WF, Healey JS, Mendoza PA, Koziarz A, Amit G, et al. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: systematic review and meta-analysis. Europace. 2019;21(6):856\u0026ndash;863.\u003c/li\u003e\n\u003cli\u003eJug B, Sebestjen M, Sabovic M, Pohar M, Keber I. Atrial fibrillation is an independent determinant of increased NT-proBNP levels in outpatients with signs and symptoms of heart failure. Wien Klin Wochenschr. 2009;121(21\u0026ndash;22):700\u0026ndash;706.\u003c/li\u003e\n\u003cli\u003eDarkner S, Goetze JP, Chen X, Henningsen K, Pehrson S, Svendsen JH. Natriuretic propeptides as markers of atrial fibrillation burden and recurrence (AMIO-CAT trial). Am J Cardiol. 2017;120(8):1309\u0026ndash;1315.\u003c/li\u003e\n\u003cli\u003eDong C, Wang K, Di Tullio MR, Gutierrez C, Koch S, Garc\u0026iacute;a EJ, et al. Disparities and temporal trends in stroke care outcomes in patients with atrial fibrillation. Int J Cerebrovasc Dis Stroke. 2019;2(1).\u003c/li\u003e\n\u003cli\u003eWu VC, Wang CL, Huang YC, Tu HT, Huang YT, Kuo CF, et al. Bleeding associated with antiarrhythmic drugs in patients with atrial fibrillation using direct oral anticoagulants. J Am Heart Assoc. 2024;13(21):e033513.\u003c/li\u003e\n\u003cli\u003eWasham JB, Holmes DN, Thomas LE, Pokorney SD, Hylek EM, Fonarow GC, et al. Pharmacotherapy for atrial fibrillation in patients with chronic kidney disease: insights from ORBIT-AF. J Am Heart Assoc. 2018;7(18):e008928.\u003c/li\u003e\n\u003cli\u003eDesai NR, Sciria CT, Zhao X, Piccini JP, Turakhia MP, Matsouaka R, et al. Patterns of care for atrial fibrillation before, during, and at discharge from hospitalization: Get With The Guidelines-AF registry. Circ Arrhythm Electrophysiol. 2021;14(4):e009003.\u003c/li\u003e\n\u003cli\u003eDamman K, Valente MA, Voors AA, O\u0026apos;Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: meta-analysis. Eur Heart J. 2014;35(7):455\u0026ndash;469.\u003c/li\u003e\n\u003cli\u003eRahimi-Bashar F, Vahedian-Azimi A, Dalvand S, Karimi L, Moshkani M, Alimohamadi Y, et al. Prevalence of amiodarone-induced thyroid dysfunction: systematic review and meta-analysis. Curr Med Chem. 2023;30(23):2690\u0026ndash;2699.\u003c/li\u003e\n\u003cli\u003eRoss DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism. Thyroid. 2016;26(10):1343\u0026ndash;1421.\u003c/li\u003e\n\u003cli\u003eKnight BP, Gersh BJ, Carlson MD, Friedman PA, McNamara RL, Strickberger SA, et al. Role of permanent pacing to prevent atrial fibrillation. Circulation. 2005;111(2):240\u0026ndash;243.\u003c/li\u003e\n\u003cli\u003eInoue N, Ishikawa T, Sumita S, Kobayashi T, Matsushita K, Matsumoto K, et al. Suppression of atrial fibrillation by atrial pacing. Circ J. 2006;70(11):1398\u0026ndash;1401.\u003c/li\u003e\n\u003cli\u003eBrenyo A, Link MS, Barsheshet A, Moss AJ, Zareba W, Wang PJ, et al. Cardiac resynchronization therapy reduces left atrial volume and atrial tachyarrhythmias in MADIT-CRT. J Am Coll Cardiol. 2011;58(16):1682\u0026ndash;1689.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Atrial fibrillation, Amiodarone, Heart failure, Antiarrhythmic drugs, Direct oral anticoagulants, Registry","lastPublishedDoi":"10.21203/rs.3.rs-9181836/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9181836/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAtrial 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e 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.\u003c/p\u003e","manuscriptTitle":"Determinants of amiodarone use in patients with atrial fibrillation: insights from the CRAFT registry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:06:02","doi":"10.21203/rs.3.rs-9181836/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-14T10:31:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T15:11:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T12:53:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69649570913904467837736428889799622926","date":"2026-05-04T15:03:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T07:59:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332816035623574931162993334156371591234","date":"2026-04-27T08:36:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283323610339326050454030437338167185938","date":"2026-04-27T06:04:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267302467962781357192977261408495824770","date":"2026-04-24T10:58:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T06:02:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T07:38:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T05:41:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T21:11:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-03-26T21:07:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1c1f587-b850-4821-8def-22fb415c1f26","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-14T10:31:40+00:00","index":72,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T15:11:51+00:00","index":70,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T12:53:09+00:00","index":68,"fulltext":""},{"type":"reviewerAgreed","content":"69649570913904467837736428889799622926","date":"2026-05-04T15:03:41+00:00","index":67,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T07:59:19+00:00","index":48,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:06:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:06:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9181836","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9181836","identity":"rs-9181836","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}