Disopyramide in the maintenance of sinus rhythm after electroconversion of atrial fibrillation. A placebo-controlled one-year follow-up study

Karlson, BW; Torstensson, Ingemar; Abjörn, C; Jansson, Sven-Olof; Peterson, Lars E.

doi:10.1093/oxfordjournals.eurheartj.a062498

Cited by 121 publications

(20 citation statements)

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“…No trial reported the frequency of anticoagulation during the follow-up. Only 7 of the studies comparing AAs with a control reported strokes occurring during the trial, 23,32,36,41,50,55,56 but it is not certain that reporting was exhaustive. They reported a total of 20 strokes in 1755 patients treated with AAs and 6 strokes in 650 patients in the corresponding control groups.…”

Section: Other Outcomesmentioning

confidence: 99%

Antiarrhythmic Drugs for Maintaining Sinus Rhythm After Cardioversion of Atrial Fibrillation

Mouly²,

et al. 2006

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Background: A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm. We performed a systematic review to determine the effect of long-term treatment with those drugs on death, embolisms, adverse effects, and atrial fibrillation recurrence.Methods: We searched MEDLINE, EMBASE, the Cochrane Library (all up to May 2005), and the reference lists of retrieved articles. We included randomized controlled trials that compared any antiarrhythmic against control (placebo or no treatment) or another antiarrhythmic, for more than 6 months. Postoperative atrial fibrillation was excluded. Two evaluators independently reviewed the retrieved studies and extracted all data. Disagreements were resolved by discussion. All results were calculated at 1 year of follow-up.Results: Forty-four trials were included, with a total of 11 322 patients. Several class IA (disopyramide phos-phate, quinidine sulfate), class IC (flecainide acetate, propafenone hydrochloride), and class III (amiodarone, dofetilide, sotalol hydrochloride) drugs significantly reduced recurrence of atrial fibrillation (number needed to treat, 2-9), but all increased withdrawals due to adverse effects (number needed to harm [NNH], 9-27) and all but amiodarone and propafenone increased proarrhythmia (NNH,. Class IA drugs, pooled, were associated with increased mortality compared with controls (Peto odds ratio, 2.39; 95% confidence interval, 1. P=.04; NNH, 109). No other antiarrhythmic showed a significant effect on mortality compared with controls. We could not analyze other outcomes because data were lacking. Conclusion:Class IA, IC, and III drugs are effective in maintaining sinus rhythm but increase adverse effects, and class IA drugs may increase mortality.

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Section: Other Outcomesmentioning

confidence: 99%

Antiarrhythmic Drugs for Maintaining Sinus Rhythm After Cardioversion of Atrial Fibrillation

Mouly²,

et al. 2006

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“…When compared, quinidine may be superior to verapamil, and amiodarone seems especially effective in patients with enlarged atria. [8][9][10][11][12] Sotalol is a ,3-blocking drug with class III antiarrhythmic properties. 13 In patients with atrial fibrillation after open heart surgery, sotalol has been shown to be superior to digitalis and disopyramide in converting atrial fibrillation in the early postoperative phase after coronary artery bypass grafting.…”

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confidence: 99%

Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation.

1990

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This open, parallel-group study compares quinidine and sotalol treatment for maintenance of sinus rhythm after direct current conversion of patients with chronic atrial fibrillation. The patients from 15 centers in Sweden were randomized to sotalol (98 patients) or quinidine (85 patients) after 2 hours of sinus rhythm after direct current conversion. According to primary efficacy assessment, 52% of the patients in the sotalol group and 48% of the patients in the quinidine group remained in sinus rhythm during the following 6-month treatment period (NS). Furthermore, 34% of the patients treated with sotalol and 22% of the patients treated with quinidine relapsed into atrial fibrillation (NS). Heart rate after relapsing into atrial fibrillation was higher in the patients treated with quinidine (109 beats/min) than in the patients treated with sotalol (78 beats/min, p

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“…Several small trials have examined the efficacy of the commonly used antiarrhythmic drugs after cardioversion of AF (table 1) [45, 46, 47, 48, 49, 50, 51, 52]. While statistically significant benefit is achieved in only some of the antiarrhythmics versus placebo, the trend towards more successful maintenance of sinus rhythm with these class IA, IC, and III agents exists.…”

Section: Antiarrhythmic Drugs In Maintaining Nsr After Cardioversion mentioning

confidence: 99%

“…In short, to look at the gross numbers across the different trials (with 6–12 months follow-up), NSR is maintained with placebo 30–35% of the time [47, 50, 51]and the majority of antiarrhythmics maintain NSR in approximately 40–60% of patients [45, 46, 47, 48, 50, 51, 52, 57, 58]. Amiodarone is effective in maintaining sinus rhythm in approximately 50–80% of patients over a follow-up of roughly 6 months to 3 years [59, 60, 61, 62, 63, 64, 65, 66].…”

Section: Antiarrhythmic Drugs In Maintaining Nsr After Cardioversion mentioning

confidence: 99%

Antiarrhythmic Agents in Facilitating Electrical Cardioversion of Atrial Fibrillation and Promoting Maintenance of Sinus Rhythm

Marcus¹,

Sung

2001

Cardiology

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Atrial fibrillation (AF) is a prevalent arrhythmia associated with significant morbidity and mortality. Electrical cardioversion of AF is a potentially definitive treatment, but as little as 67% of patients may be successfully cardioverted and, after normal sinus rhythm (NSR) is achieved, AF often recurs. Class IA, IC, and III antiarrhytmic agents are used for both facilitation of electrical cardioversion and subsequent maintenance of NSR. The mechanisms of these agents may be related to suppressing automaticity, prolonging the wavelength of reentrant wavelets, and preventing electrical remodeling. The possibility of proarrhythmia and other adverse effects complicates use of these drugs, and no large trials have been completed to elucidate definite indications. Several factors may predict failure with electrical cardioversion alone (duration of AF, atrial size, age, underlying disease, and factors that affect transthoracic impedance), calling for empiric pharmacotherapy to facilitate cardioversion. For this purpose, class IA agents hold some promise, evidence for class IC agents is conflicting, and class III agents are the most effective. Adverse effects are rare given the short course before cardioversion, but ibutilide, the most efficacious in this regard, may be proarrhythmic after only a single dose. In promoting maintenance of sinus rhythm, antiarrhythmics across the different classes have similar efficacies: NSR may be maintained in ∼40–65% of patients compared to ∼30–35% with placebo at 1 year. Amiodarone is distinct in its success, with ∼60–80% of patients remaining in NSR. For all of these agents, long-term therapy may lead to proarrhythmia or other substantial adverse effects. Finally, a serial antiarrhythmic strategy may be effective, with maintenance of NSR and minimal adverse effects ultimately achieved by trial and error.

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Disopyramide in the maintenance of sinus rhythm after electroconversion of atrial fibrillation. A placebo-controlled one-year follow-up study

Cited by 121 publications

References 0 publications

Antiarrhythmic Drugs for Maintaining Sinus Rhythm After Cardioversion of Atrial Fibrillation

Antiarrhythmic Drugs for Maintaining Sinus Rhythm After Cardioversion of Atrial Fibrillation

Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation.

Antiarrhythmic Agents in Facilitating Electrical Cardioversion of Atrial Fibrillation and Promoting Maintenance of Sinus Rhythm

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