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

Abstract

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<O.OO1). Patients treated with sotalol were found to be less symptomatic at the time of relapse compared with relapsing patients in the quinidine group. In terms of safety, more patients were withdrawn from quinidine than from sotalol treatment (26% vs. 11%, p<O.05), and sotalol was generally better tolerated than quinidine. Twenty-eight percent of the patients treated with sotalol and 50% of the patients treated with quinidine reported side effects (p<0.01). The difference was primarily a result of early (within the first month of treatment) gastrointestinal and skin side effects in the group of patients treated with quinidine. It is concluded that sotalol is an effective and well-tolerated alternative for maintenance of sinus rhythm after direct current conversion of chronic atrial fibrillation, and that sotalol has the ability to control ventricular rate in patients with relapse into atrial fibrillation. (Circulation 1990;82:1932-1939 Ch hronic atrial fibrillation is a common arrhythmia1 affecting about 4% of a general middleaged population.2 The hemodynamic response to atrial fibrillation is a decrease in stroke volume, which may be reduced by as much as 25% by the loss of effective atrial contractions in the failing heart.3 The performance is usually not readily normalized or improved4,5 even if heart rate is controlled

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

“…Up to 30% of patients taking quinidine experience intolerable side effects, most commonly diarrhea. Other investigators 614 found sotalol and quinidine equally effective for maintaining sinus rhythm after direct-current cardioversion of AF. Sotalol, but not quinidine, reduced heart rate in patients with recurrent AF, and there were fewer symptoms with sotalol.…”

“…609 Sotalol was as effective as and better tolerated than slowrelease quinidine sulfate for preventing recurrent AF in a multicenter study. 614 Moreover, sotalol was more effective in suppressing symptoms in patients who relapsed into AF, probably because it induced a slower ventricular rate. In patients with recurrent AF, propafenone was as effective as sotalol in maintaining sinus rhythm 1 y after cardioversion.…”

“…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).…”

Atrial Fibrillation: The New Epidemic of the Ageing World

“…122 At 6-month follow-up, 48% of quinidine-treated patients and 52% of sotalol-treated patients remained in sinus rhythm. 135 At 1-year follow-up of 100 patients with AF cardioverted to sinus rhythm, 37% of 50 patients randomized to sotalol and 30% of 50 patients randomized to propafenone remained in sinus rhythm. 136 In a study of 403 patients with at least 1 episode of AF in the prior 6 months, 201 patients were treated with amiodarone and 202 patients were treated with sotalol or propafenone.…”

Recurrence of Atrial Fibrillation After Internal Cardioversion of Persistent Atrial Fibrillation Prognostic Importance of Electrophysiologic Parameters

“…Unfortunately, despite the use of antiarrhythmic drugs and serial cardioversions, the incidence of AF recurrence ranges from 40% to 50% in the first year. [8][9][10] It has been shown that recurrence of AF relates to atrial electrophysiologic properties. Recent animal studies have shown that AF results in a marked shortening of the atrial effective refractory period (ERP) or monophasic action potential (MAP) and loss of its physiological ability to adapt to rate.…”