Amiodarone, Sotalol, or Propafenone in Atrial Fibrillation: Which Is Preferred to Maintain Normal Sinus Rhythm?

Abstract

Amiodarone, Sotalol, or Propafenone in Atrial Fibrillation: Which Is Pre ferred to Maintain Normal Sinus Rhythm? This randomized study compared the efficacy and safety of amiodarone, propafenone and sotalol in the prevention of atrial fibrillation. Methods: The population consisted of 214 consecutive patients (mean age 64 ± 8 years, 106 men) with recurrent symptomatic atrial fibrillation. After restoration of sinus rhythm, patients were randomized to amiodarone (200 mg/day), propafenone (450 mg/day) or sotalol (320 ± 20 mg/day). Follow-up evaluations were conducted at 1,2, 4 and 6 months, and at 3-month intervals thereafter. The proportion of patients developing recurrent atrial fibrillation and/or experiencing unacceptable adverse effects was measured in the three groups by the Ka plan-Meier method. Results: Recurrent atrial fibrillation occurred in 25 of the 75 patients treated with amiodarone compared to 51 of the 75 patients treated with sotalol and 24 of the 64 patients treated with propafenone. Fourteen patients treated with amiodarone, five with sotalol, and one with propafenone ex perienced adverse effects while in sinus rhythm, necessitating discontinuation of treatment (P < 0.001 for amiodarone and propafenone vs sotalol). The difference between amiodarone and propafenone was sta tistically nonsignificant when all events were included in the analysis. However, if the analysis was lim ited to recurrent atrial fibrillation events, amiodarone was more effective than propafenone (P < 0.05). Conclusions: Amiodarone and propafenone were superior to sotalol in maintaining long-term normal si nus rhythm in patients with atrial fibrillation. Amiodarone tended to be superior to propafenone, though its long-term efficacy was limited by adverse side effects. (PACE 2000; 23[Pt. II] -.1883-1887) amiodarone, sotalol, propafenone, atrial fibrillation, sinus rhythm maintenance DefinitionsParoxysmal AF was defined as recurrent selfterminating episodes lasting < 48 hours, alternat- PACE, Vol. 23 N o v e m b e r 2000, Part II 1883

Melanocyte-like cells in the heart and pulmonary veins contribute to atrial arrhythmia triggers

“…However, PV isolation is associated with complications and risks, including PV reconnection, which reduces its efficacy (8)(9)(10). On the other hand, pharmacologic anti-arrhythmic therapy for AF is often ineffective and associated with burdensome side effects (11)(12)(13).…”

Errors and pitfalls in the non-invasive management of atrial fibrillation

“…Nevertheless, it is believed that the percentage of patients that experience asymptomatic short episodes of AF after successful cardioversion is even greater [21]. Accumulating evidence suggests that the best drug for sinus rhythm maintenance is amiodarone (30-35% relapse after 1 year) [44,45]. Alternative agents with proved but lower efficacy than amiodarone are propafenone, and sotalol [45,46].…”

“…Accumulating evidence suggests that the best drug for sinus rhythm maintenance is amiodarone (30-35% relapse after 1 year) [44,45]. Alternative agents with proved but lower efficacy than amiodarone are propafenone, and sotalol [45,46]. Even though dofetilide has been proved to be effective for maintenance of sinus rhythm, its long-term use without appropriate monitoring can pose the patients to the threat of torsade de pointes [47].…”

Pharmacologic management of atrial fibrillation in the elderly: Rate control, rhythm control, and anticoagulation

“…Amiodarone has at least a modest efficacy as a stand-alone medicine for pharmacologic conversion of AF. However, because electrical cardioversion is by far more effective, amiodarone is more often used to enhance success rates of DC cardioversion (when administered periprocedurally) [36], to achieve safe outpatient conversion of chronic AF when prescribed long-term [37], and to maintain normal sinus rhythm [38]. Amiodarone can cause bradycardia, necessitating pacemaker implantation, in order to continue the drug; this appears to be a more substantial risk in elderly women with coronary artery disease and those on concomitant digoxin therapy [39•].…”