Quinidine in maintenance of sinus rhythm after electroconversion of chronic atrial fibrillation. A controlled clinical study.

Hillestad, Leif; Bjerkelund, C; Dale, Jon; Maltau, Jan Martin; Storstein, O

doi:10.1136/hrt.33.4.518

Cited by 92 publications

(22 citation statements)

References 9 publications

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“…Ischemia and "lone" AF were representative cardiac diagnoses of 16% and 12% of dosages.18-20,22 Desired quinidine levels varied from patients, respectively. Slightly more patients with 1-3 mg/l in the paper by Hartel et al19 to 4-6 mg/I in ischemic heart disease or thyroid dysfunction were the paper by Hillestad et al 20 Only the paper by randomized to quinidine as opposed to control, but Byrne-Quinn and Wing18 reported the actual quinithese differences were not statistically significant. dine levels measured (mean of 2.2 mg/l, which was in This suggests that randomization was successful in the middle of the therapeutic range for the assay distributing patients with various underlying diagused) and did not find a statistically significant difnoses approximately equally to quinidine and control ference in quinidine levels in those patients relapsing groups.…”

Section: Characteristics Of Trials Analyzedmentioning

confidence: 97%

“…In three papers, details of the duration of AF in the two treatment groups were provided, and there were no significant differences in the duration of AF between the quinidine and control groups in any of those trials. 19,20,22 The various cardiac diagnoses and possible etiologies of AF in each studiy are shown in Table 2.…”

Section: Characteristics Of Trials Analyzedmentioning

confidence: 99%

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Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials.

et al. 1990

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Because individual studies evaluating the role of quinidine in the maintenance of sinus rhythm after cardioversion from chronic atrial fibrillation have involved relatively few patients, a meta-analysis of randomized control trials was performed. Six trials published between 1970 and 1984 were selected by two blinded reviewers based on study design and statistical analysis. Data from these six trials involving 808 patients were pooled after testing for homogeneity of treatment effects across trials. Life table estimates of the percent of patients still in sinus rhythm at 3, 6, and 12 months after cardioversion were constructed for quinidine and control groups. The proportion of patients remaining in sinus rhythm in the quinidine group was 69O, 58%, and 50% at 3, 6, and 12 months postcardioversion respectively. The proportion of patients remaining in sinus rhythm in the control group was 45%, 33%, and 25% at the same time intervals. The pooled rate difference, or difference in proportion of patients in sinus rhythm between quinidine and control groups, was 24%, 23%, and 24% at 3, 6, and 12 months of follow-up (p<0.001 at all time intervals). The unadjusted total mortality rate in the quinidinetreated patients was 2.9%o and in the control group was 0.8%. The odds of dying in the quinidine-treated group were approximately three times that of the control group ("typical" odds ratio= 2.98, p<0.05). Thus, quinidine treatment is more effective than no antiarrhythmic therapy in suppressing recurrences of atrial fibrillation but appears to be associated with increased total mortality. (Circulation 1990;82:1106-1116 54%.3-5 In some studies administration of quinidine was stopped because of an unacceptably high incidence of toxicity that included ventricular fibrillation, syncope, and death.5,6 Nevertheless, a precise estimate of mortality secondary to quinidine is lacking in the literature. This is particularly relevant in light of recent observations regarding the proarrhythmic potential of antiarrhythmic agents and the recently published report of the Cardiac Arrhythmia Suppression Trial,7 which demonstrated increased mortality in patients randomized to encainide and flecainide treatment for suppression of ventricular arrhythmias after myocardial infarction.

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Section: Characteristics Of Trials Analyzedmentioning

confidence: 97%

Section: Characteristics Of Trials Analyzedmentioning

confidence: 99%

Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials.

et al. 1990

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“…Sotalol, but not quinidine, reduced heart rate in patients with recurrent AF, and there were fewer symptoms with sotalol. 535,592,614,[617][618][619][620][621][622][623][624] In 2 European multicenter studies, the combination of quinidine plus verapamil was as effective as or superior to sotalol in preventing recurrences of paroxysmal and persistent AF. In the Suppression Of Paroxysmal Atrial Tachyarrhythmias (SOPAT) trial, 625 1033 patients (mean age 60 y, 62% male) with frequent episodes of symptomatic paroxysmal AF either received high-dose quinidine (480 mg per day) plus verapamil (240 mg per day; 263 patients), low-dose quinidine (320 mg per day) plus verapamil (160 mg per day; 255 patients), sotalol (320 mg per day; 264 patients), or placebo (251 patients).…”

Section: Agents With Proven Efficacy To Maintain Sinus Rhythmmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,879

590

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“…Despite high initial success rates of DC cardioversion the long-term results, especially after atrial fibrillation, are not as good with approximately 25-60% remaining in sinus rhythm after 1 year [4][5][6]. In previous studies that attempted to find predictive factors to identify patients likely to remain in sinus rhythm after cardioversion, long duration of the arrhythmia was most frequently associat ed with poor long-term success [7,8], The role of left atrial enlargement on echocardiography is less clear.…”

Section: Introductionmentioning

confidence: 99%

Factors Predicting Maintenance of Sinus Rhythm after Direct Current Cardioversion of Atrial Fibrillation and Flutter: A Reanalysis with Recently Acquired Data

Arnar

Daníelsen²

1996

Cardiology

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A prospective study was conducted to evaluate how many patients maintain normal sinus rhythm after direct current (DC) cardioversion of atrial arrhythmias and to assess factors predictive of long-term success. The study group consisted of 61 patients (45 men) aged 18-88 years (mean age 66 ± 11 years) who underwent cardioversion at our department from October 1990 to June 1992. Prior to cardioversion, the patients’ medical history, medications, heart size on chest X ray, and echocardiographic findings were reviewed. Overall, 41 (67.2%) patients were in atrial fibrillation, while 20 (32.8%) had atrial flutter. Only 15% of the patients had valvular heart disease. Sinus rhythm was restored by DC cardioversion in 47 (77%) patients, none of whom experienced an embolic event prior to discharge. Patients with atrial flutter had a higher conversion rate (95%) than those in atrial fibrillation (68.3%; p = 0.024), and also patients with an arrhythmia for less than 1 week (94.4%) compared to those with a longer or unknown duration (69.8%; p = 0.047). The primary success rate was not influenced by heart size on chest X ray or echocardiographic variables. The study protocol aimed at following up the patients for 1 year after cardioversion. Of the 47 patients who converted to sinus rhythm data are available on 44 for a mean follow-up of 11 ± 3 months (range 1-14 months), at which time 25 (57%) still remained in sinus rhythm. Heart size on the chest X ray was significantly increased in the group that did not maintain sinus rhythm (p = 0.03) and their left atrial size on echocardiography was slightly increased (p = 0.10). Patients who originally had atrial flutter were more likely to remain in sinus rhythm than those who had been in atrial fibrillation (p = 0.12), as did patients with an arrhythmia for less than 1 week prior to cardioversion in comparison to those with a longer or unknown duration (p = 0.11). Thus, in contrast to previous reports, according to these recent data on a patient population with a low prevalence of valvular heart disease, DC cardioversion can be attempted in most patients with atrial tachyarrhythmias. Clinical factors, heart size on chest X ray and echocardiographic findings should, however, be considered before deciding to perform DC cardioversion.

show abstract

Quinidine in maintenance of sinus rhythm after electroconversion of chronic atrial fibrillation. A controlled clinical study.

Cited by 92 publications

References 9 publications

Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials.

Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials.

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Factors Predicting Maintenance of Sinus Rhythm after Direct Current Cardioversion of Atrial Fibrillation and Flutter: A Reanalysis with Recently Acquired Data

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