Value of quinidine in maintenance of sinus rhythm after electric conversion of atrial fibrillation.

One hundred patients were subjected to a controlled study of the effectiveness of quinidine treatment upon the maintenance of sinus rhythm after electroconversion. The quinidine series was treated with a long-acting preparation of quinidine sulphate, which was given in a dosage to achieve serum levels between 4 and 6 mg/l. The control series received no quinidine. The Recently this need has been met by two such studies (Hartel et al., I970; Byrne-Quinn and Wing, 1970), both showing the effectiveness of quinidine in preserving sinus rhythm

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“…It thus corroborates the results of the two other controlled studies (Hartel et al, 1970;Byrne-Quinn and Wing, 1970).…”

Section: Discussionsupporting

confidence: 91%

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

Hillestad¹,

Bjerkelund²,

Dale³

et al. 1971

Heart

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“…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%

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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“…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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Value of quinidine in maintenance of sinus rhythm after electric conversion of atrial fibrillation.

Cited by 75 publications

References 9 publications

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

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

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

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