Objective To determine the effect of intravenous amiodarone on the rapid ventricular rate in the patients with atrial fibrillation (AF) and congestive heart failure (CHF). Methods Seventy elderly patients with AF and CHF [ventricular rate ＞120beats/min, New York Heart Association (NYHA) class Ⅱ?Ⅳ] hospitalized in the Northern Jiangsu People’s Hospital from September 2012 to September 2013 were recruited in this study. They were randomized into 2 groups: amiodarone group (n＝35, loading dosage of 150mg followed by a dose of 1.5mg/min) and deslanoside group (n＝35, loading dosage of 0.4 or 0.2mg in slow injection, and more 0.2mg should be medicated if no effect occurred in 1h later). The ventricular rate, mean response time, successful cardioversion ratio, brain natriuretic peptide (BNP) level, the adverse effects and follow-up outcomes were recorded after medication. Results The ventricular rate was significantly decreased in 1, 2 and 24h after treatment than before in both groups (P＜0.01), even in 30 min in amiodarone group (P＜0.01). In 2h after treatment, the ventricular rate was reduced by 47% in amiodarone group and by 28% in deslanoside group when compared with the rate before treatment. Significant difference was found in the rate between the 2 groups in 30min, 1h, 2h and 24h after treatment (P＜0.01). The total effective rate on controlling rapid AF was 79.8% (amiodarone group) and 72.3% (deslanoside group) respectively (P＞0.05). In 3 months after discharged from hospital, the ratio of persistent AF after the medications (amiodarone, metoprorol and digoxin) was 60.0% (21/35) and 82.9% (29/35), respectively, and the rate of adverse effect was 8.6% and 11.4%, respectively, in the 2 groups (P＞0.05). Conclusion Amiodarone is of safety, rapid effect and mild adverse effect in treatment of CHF patients with coexisting AF.