Intravenous propafenone in paroxysmal atrial fibrillation: A randomized, placebo‐controlled, double‐blind, multicenter clinical trial

Abstract

Btrckgtuund: Pharmacological conversion of paroxysmal atrial fibrillation is frequently necessary. The aim of this study was to compare intravenous propafenone, a class Ic antiarrhythmic agent, with placebo in paroxysmal atrial fibrillation (AF) of recent onset (< 72 h).Pdienrs and merhods: We randomly allocated 75 patients, aged 18 to 70 years, with paroxysmal AF to receive intravenous propafenone (2 mg/kg in I5 min followed by 1 mgkg in 2 h) or the matching placebo. Patients were followed for 3 h. Exclusion criteria were the presence of one of the following: clinical heart failure, recent acute myocardial infarction, hypotension, atrioventricular block, Wolff-Parkinson-White syndrome, or current treatment with antiarrhythmic agents or digitalis.Resulrs: No sign of heart disease was found in 74.7% of the patients. Echocardiographically determined left atrium dianieter was similar in the two groups. Conversion to sinus rhythm occurred in 24 of 41 patients allocated to propafenone and in 10 of 34 patients allocated to placebo (odds ratio 3.2, 95% confidence intervals 1.3-7.9; p<O.OI). Mean conversion time was 34 ? 29 and 71 f 55 niin, respectively, for propafenone and placebo. Mean heart rate in nonconverters decreased from 146 to 109 beatshin in patients treated with propafenone while it remained virtually unchanged in those treated with placebo. Only minor side effects were noted. Conclusions: Intravenous propafenone is an effective therapeutic option for restoring sinus rhythm in patients with paroxysmal AF of recent onset.

Systematic Review and Meta-analysis of the Efficacy of Cardioversion by Vernakalant and Comparators in Patients with Atrial Fibrillation

“…This analysis suggests 3 antiarrhythmic agents, flecainide (IV and oral), propafenone (IV), and vernakalant (IV), were superior to placebo in achieving cardioversion within 2 h of [59,64,65,57,60,39,66,61,62,63,70,14,41,38] a In two studies of vernakalant, [38,41] efficacy data were reportedly separately for patients with short-and long-duration AF whereas the safety results were reported with these groups combined. In our review of the safety data, we included all of the AEs reported in these patients, although the meta-analysis of efficacy included data only from the short-duration AF groups treatment administration.…”

Vernakalant Hydrochloride for Rapid Conversion of Atrial Fibrillation

“…17,18,20,21 Intravenous flecainide and propafenone reportedly successfully terminate recent-onset AF in Ͼ50% to 60% of patients. [22][23][24][25][26][27][28] These formulations are not available in North America, 4,19 however, and they have significant proarrhythmic and negative inotropic potential. 22,23,25,26 Procainamide is used despite a risk-to-benefit profile that is inferior to ibutilide or flecainide.…”

Review : Electrophysiologic and Antiarrhythmic Effects of Propafenone: Focus on Atrial Fibrillation

“…More recently, using patients with AF of less than 72 hours' duration, Fresco et al (85) studied the effects of intravenous propafenone, 2 mg/kg, given over 15 minutes, followed by 1 mg/kg over 2 hours. After 3 hours, conversion to sinus rhythm occurred in 59% of the treatment group and in 29% of the placebo group (P < .01), and it occurred earlier (34 vs. 71 minutes) after the infusion.…”