Comparison of sotalol versus quinidine for maintenance of normal sinus rhythm in patients with chronic atrial fibrillation

Southworth, Mary Ross; Zarembski, Dawn G.; Viana, Marlos A. G.; Bauman, Jerry L.

doi:10.1016/s0002-9149(99)00168-x

Cited by 28 publications

(7 citation statements)

References 20 publications

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“…11-13 18 23 Even though we used a low maintenance dose, we found that amiodarone caused various non-cardiac side effects, the incidence of which increased over time. This may be because many side effects are related to the total dose given, or to the total dose given over time—that is, to the amount of drug that has accumulated.…”

Section: Discussionmentioning

confidence: 94%

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study

Kochiadakis

Igoumenidis

Marketou

et al. 2000

Heart

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Objective-To assess and compare the safety and eYcacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation. Design-Prospective, randomised, single blind, placebo controlled study. Setting-Tertiary cardiac referral centre. Patients-186 consecutive patients (97 men, 89 women; mean (SD) age, 63 (10) years) with recurrent, symptomatic atrial fibrillation. Interventions-65 patients were randomised to amiodarone, 61 to sotalol, and 60 to placebo. Patients receiving amiodarone were maintained at a dose of 200 mg/day after a 30 day loading phase. The sotalol dose was 160-480 mg daily, as tolerated. Main outcome measures-Recurrence of atrial fibrillation or side eVects. Results-In the amiodarone group, 31 of the 65 patients developed atrial fibrillation after an average of six months, while 15 (11 in sinus rhythm and four in atrial fibrillation) experienced significant side eVects after an average of 16 months. In the sotalol group, relapse to atrial fibrillation occurred in 47 of the 61 patients after an average of eight months; three experienced side eVects during the titration phase. In the placebo group, 53 of the 60 patients developed atrial fibrillation after an average of four months (p < 0.001 for amiodarone and sotalol v placebo; p < 0.001 for amiodarone v sotalol). Conclusions-Both amiodarone and sotalol can be used for the maintenance of normal sinus rhythm in patients with symptomatic atrial fibrillation. Amiodarone is more eVective but causes more side eVects. (Heart 2000;84:251-257) Keywords: amiodarone; sotalol; atrial fibrillation Various antiarrhythmic drugs, especially those belonging to class I (quinidine, procainamide, flecainide, propafenone), have been used to prevent recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation or with chronic atrial fibrillation after successful cardioversion. However, their use is fraught with problems, including incomplete eYcacy, proarrhythmic properties, and possibly increased mortality. [1][2][3][4][5][6][7][8][9][10] Recently, the development of new antiarrhythmic agents has focused on the class III mode of action-that is, the prolongation of myocardial repolarisation and refractoriness.2-5 11-13 Only two antiarrhythmic agents that are available on the market and are suitable for long term administration possess this property-sotalol and amiodarone. [14][15][16][17][18] Previous studies suggest that both these drugs are eVective in the management of refractory atrial fibrillation. However, the data must be interpreted with caution because of small sample sizes, short follow up, and the fact that most of the studies were not controlled or randomised.This prospective, randomised, single blind trial was designed: first, to determine whether amiodarone and sotalol are superior to placebo for the long term maintenance of sinus rhythm in patients with recurrent, symptomatic atrial fibrillation; second, to examine the safety of the drugs when used in this setting; and third, to compare ...

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Section: Discussionmentioning

confidence: 94%

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study

Kochiadakis

Igoumenidis

Marketou

et al. 2000

Heart

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“…Atrial fibrillation results from different, altered metabolic, mechanical, structural, and signaling mechanisms, such as rearrangements of extracellular matrix (e.g., fibrosis), or cytoskeletal and atrial myocyte damage [78][79][80]. The RAAS plays a key role in the morphological and functional remodeling of the ventricle, but available data for the atrium are very limited.…”

Section: Efficacy Of Raas Blockers In the Prevention Of Atrial Fibrilmentioning

confidence: 99%

Efficacy of Angiotensin Receptor Blockers in Cardiovascular Disease

Maggioni

2006

Cardiovasc Drugs Ther

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The cardiovascular continuum describes the progression of pathophysiologic events from cardiovascular risk factors to symptomatic cardiovascular disease (CVD) and life-threatening events. Pharmacologic intervention early in the continuum may prevent or slow CVD development and improve quality of life. The renin-angiotensin-aldosterone system (RAAS) is central to the pathophysiology of CVD at many stages of the continuum. Numerous clinical trials of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have shown that RAAS blockade provides benefits to patients across the continuum. ARBs are as effective as ACE inhibitors in the treatment of hypertension; however tolerability and adherence to therapy appear to be improved with ARBs. Large clinical trials have shown that ARBs may provide therapeutic benefits beyond blood pressure control in patients with diabetes, heart failure or at risk of heart failure following a myocardial infarction. In addition, ARBs have been shown to provide protective effects in patients with impaired renal function or left ventricular hypertrophy. Additional clinical trials are ongoing to further characterize the role of ARBs in CVD management.

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“…Digoxin has no effect and pure β-blockers have a small beneficial effect in maintenance of sinus rhythm [27,28]. Class IA, IC, and III agents have proven efficacy in maintaining sinus rhythm, and most drugs, including flecainide, propafenone, and sotalol are equally effective and usually well tolerated [29,30]. The Canadian Trial of Atrial Fibrillation trial [28] compared low-dose amiodarone (200 mg/d) to sotalol and propafenone, and provided evidence for superiority of amiodarone in maintaining sinus rhythm over sotalol and propafenone, which were equally efficacious.…”

Section: Maintenance Of Sinus Rhythmmentioning

confidence: 99%

Evolving concepts in the treatment of atrial fibrillation

Maniar

Steinberg

2003

Curr Cardiol Rep

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Atrial fibrillation (AF) is common among older adults, and its prevalence is increasing due to an aging population. This article reviews the recent insights into the mechanisms of AF, new developments in pharmacologic and nonpharmacologic therapy, and the impact of recent randomized clinical trials in the management of AF. Randomized clinical trials have shown that rhythm control with antiarrhythmic drugs offers no advantage over rate control for the prevention of death and cardiovascular morbidity. Catheter ablation of AF may play an increasingly important role in the future.

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Comparison of sotalol versus quinidine for maintenance of normal sinus rhythm in patients with chronic atrial fibrillation

Cited by 28 publications

References 20 publications

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study

Efficacy of Angiotensin Receptor Blockers in Cardiovascular Disease

Evolving concepts in the treatment of atrial fibrillation

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