engleski

Pharmacologic conversion of atrial fibrillation in patients with normal or borderline systolic function: amiodarone versus propafenone, with quinidine as a reserve option

Selection of the most appropriate antiarrhythmic drug for conversion of paroxysmal atrial fibrillation (PAF) is still a matter of discussion. According to literature, amiodarone is the most often used drug, propafenone has some advantages in certain pathological entities, while the role of quinidine is recently renewed. The aim of the study was to define efficiency of the above mentioned drugs in the PAF conversion, using quinidine as a third-line therapy. Methods: One hundred and forty patients with up to 48 hours old PAF were included into a prospective 4-year study. Patients with chronic ischemic heart disease, or hypertensive or valvular heart disease, and those with lone AF, were included. Congestive heart failure, ejection fraction below 40% and hemodynamical instability were excluding criteria. 77 patients were male and 63 female, aged 21 to 83 (62&plusmn ; 12) years. Among 61 patients with first episode of PAF, those with ischemic heart disease received amiodarone, while the others received propafenone, as a first line therapy. If there was no success (if the drug of a first choice failed), study drugs were crossed over. Quinidine was used as a third line therapy. In 79 patient with PAF relapse, conversion attempt was empirical. Chi-square test and Fisher exact test were used, when appropriate. Results: Amiodarone was more effective than propafenone (p<0.0001) in both cases, if used as a first (p<0.005) or a second line drug therapy (p<0.05). Quinidine was even more effective than amiodarone, but the difference did not reach statistical significance (NS). Efficiency of each drug did not differ when used as a drug of first or second choice (NS), or if used as third line therapy, as in the case of quinidine. (Table 1). Electrical cardioversion had to be done in 3 patients, each time successfully. Iz was done in two patients as a second line and in one as a third line therapy ; in one after first PAF episode and in two pts. with recidivant episode. Table 1. Efficiency of antiarrhythmic drugs in conversion of PAF propafenone amiodarone quinidine total successful attempts 47/94 (50%) 76/92 (83%) 14/14 (100%) as a first line therapy 44/88 38/50 2/2 as a second line therapy 3/6 38/42 6/6 as a third line therapy 0/0 0/0 6/6 in the first PAF episode 29/45 29/31 2/2 in a recidivate episode 18/49 47/61 12/12 Phlebitis, hypotension and other side-effects did not result in termination of PAF conversion attempts, as well as self-terminated Torsade-de-Pointes that had occurred after conversion in two patients, one on propafenone therapy and another on quinidine. Recurrence of the arrhythmia was noted in 5% of patients during the 48 hours period. Conclusion: For medicament conversion of PAF, amiodarone has been shown to be superior to propafenone. Quinidine may serve as a reserve option prior to electrical cardioversion.

Atrial fibrillation; Pharmacologic conversion

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