Flecainide versus quinidine for conversion of atrial fibrillation to sinus rhythm

Borgeat, Alain; Goy, Jean‐Jácques; Maendly, R; Kaufmann, U; Grbić, M; Sigwart, U

doi:10.1016/0002-9149(86)90022-6

Cited by 174 publications

(51 citation statements)

References 23 publications

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“…The evaluation of drug efficacy by comparing different studies is difficult because of differences in study population characteristics and methodologies including underlying heart disease, duration of arrhythmia, dose and route of drug administration, the monitoring time and, the study endpoints. Pharmacological cardioversion seems to be mostly effective when initiated within first week of the onset of an AF episode (10,11). A large proportion of patients with recent-onset AF experience spontaneous cardioversion within 24 to 48 hours after AF onset (12,13).…”

Section: Discussionmentioning

confidence: 99%

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Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Balla¹,

Petrela²,

Kondili³

2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Atriyal fibrilasyonun (AF) sinüs ritmine döndürülmesi çoğu kez emboli riskini ve hemodinamik bozulmanın azaltılması için yapılır. Bu çalışmada, son 48 saat içinde AF geçirmiş hastalar üzerinde tek oral doz flekainid, amiyodaron ve propafenon ile atriyal fibrilasyonun sinüs ritmine dönüşümü üzerindeki etkileri plasebo ile randomize olarak karşılaştırılmıştır. Yöntemler: Bu çalışma 160 hasta üzerinde yapılmış, hastalara rastgele olmak üzere flekainid (3 mg/kg, n=40), amiyodaron (30 mg/kg, n=40), propafenon (8.5 mg/kg, n=40) veya placebo (n=40) verilmiştir. Amaçlanan nokta ilaç alınımı sonrası 24 saat içinde AF'nin sinüs ritmine dönüşüm hızı olmuştur. AF konversiyon oranı ile 3 antiaritmik ilacın kullanımı ile ilişkiler çoklu lojistik regresyon analiz ile değerlendirilmiştir. Bulgular: Amaçlanan etki, flekainid kullanan hastaların %87.5'inde, amiyodaron kullanan hastaların %85'inde, propafenon kullanan hastaların 85%'inde, plasebo kullanan hastaların ise %17.5'inde (p<0.001 her 3 ilacın plasebo ile karşılaştırılması) gerçekleşmiştir. İlaç alımından 3 saat sonraki dönüşüm hızı, amiodaron (%0) ve plasebo (%10) ile karşılaştırıldığında; Propafenon grubunda (%57.5) ve flekainid grubunda (%45) olmak üzere daha yüksek bulunmuştur. Amiyodaron kullanan hastalar 6 ve 24 saat içinde, flekainid veya propafenon grubu hastalara göre anlamlı olarak daha fazla sinüs ritmine döndürülmüştür. Plasebo ile kıyaslandığında antiaritmik ilaçların kullanımı sinüs ritmine dönüştürmede belirgin derecede üstün bulundu (düzeltilmiş OR=19.53, %95 GA 3.14-121.55, p<0.001). Önemli yan etki gözlenmedi. Sonuç: Atriyal fibrilasyona yakın zamanda girmiş hastalarda oral ilaç alımını izleyen 24 saatlik süreç içinde sinüs ritmine geri döndürmede flekainid, amiyodaron veya propafenon grubu, plasebo grubuna göre üstün bulunmuştur. Propafenon ve flekainid'in oral alım sonrası ilk 3 saat içinde amiyodaron'a göre daha etkili olmakla birlikte her 3 antiaritmik ilaç benzer etkinliktedir. (Anadolu Kardiyol Derg 2011; 11: 600-6) Anahtar kelimeler: Amiyodaron, atriyal fibrilasyon, flekainid, propafenon, sinüs ritm, lojistik regresyon analizi ABSTRACT Objective: In this study, we randomly compared single oral doses of flecainide, amiodarone and propafenone versus placebo for the conversion of recent atrial fibrillation (AF) (within 48 hours). Methods: This is a randomized prospective, placebo-controlled single-blind study that included 160 consecutive patients with recent AF who were randomly assigned to single oral doses of flecainide (3 mg/kg of weight, n=40), amiodarone (30 mg/kg weight, n=40), propafenone (8.5 mg/ kg of weight, n=40) or placebo (n=40). The primary end-point was conversion rate at 24 hours after the drug intake. The association between antiarrhythmic use and conversion rate was tested with multiple logistic regressions. Results: The primary end-point was achieved in 87.5% of patients with flecainide, 85% of patients with amiodarone, 85% of patients with propafenone and 17.5% of patients with placebo (p<0.001 compared with placebo for...

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Section: Discussionmentioning

confidence: 99%

“…Under these circumstances, administration of oral amiodarone is associated with a conversion rate between 15% and 40% over 28 days (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Serious toxicity has been reported, including death due to bradycardia ending in cardiac arrest (10,(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Balla¹,

Petrela²,

Kondili³

2011

Anadolu Kardiyol Derg

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“…Quinidine does carry a risk of proarrhythmia including Torsades de Pointes with a risk of 1.5% per year [23]. The most commonly reported side effects are gastrointestinal [24,25]. There is also a small but significant risk of immune-mediated drug effects including systemic lupus and vasculitis [26].…”

Section: Quinidinementioning

confidence: 99%

“…When administering quinidine alone, the conversion efficacy ranged from 40-84% [24,25,27]. Quinidine administered with digoxin had an efficacy range of 47-86% [28,29].…”

Section: Quinidinementioning

confidence: 99%

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

En¹,

Sk²

2017

Cardiovasc Pharm Open Access

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Introduction: Cardiac arrhythmias, including supraventricular and ventricular tachycardias, portend a higher risk of morbidity and mortality. These arrhythmias also are associated with increased healthcare resource utilization, decreased quality of life, and increased activity impairment. Pharmacologic conversion is a treatment option for conversion to sinus rhythm that has the advantage of avoiding sedation from DC cardioversion.

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“…[4][5][6][7][8][9][10][11][12][13] Proarrhythmic concerns have limited the usefulness of anti-arrhythmic therapy in the un-monitored setting 6,8,9,14,15 as has, in some patients, bradycardic concerns and concerns about the potential transition of AF to atrial flutter with a rapid ventricular response when class IC or IA agents are used. However, in properly chosen patients, those without structural heart disease (SHD), high dose oral anti-arrhythmic agents (usually 75 to 100% of the normal daily dose of propafenone or flecainide given as a single oral dose) may effectively and safely convert 70-80% of patients with recent-onset, new or recurrent, AF [10][11][12][13] in an out-patient setting.…”

Section: 2mentioning

confidence: 99%

The Conversion of Paroxysmal or Initial Onset Atrial Fibrillation with Oral Ranolazine: Implications for a New "Pill-In-Pocket" Approach in Structural Heart Disease

Murdock¹,

Reiffel²,

Kaliebe³

et al. 2010

J.A.F.I.B

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Background : The "Pill-in-Pocket" (PIP) is an approach to atrial fibrillation (AF) where oral anti-arrhythmics at 75% to 100% of the normal daily dose, given as a single dose, is used to convert recent-onset AF. Pro-arrhythmic risk has limited this approach to patients without structural heart disease (SHD). Ranolazine is an anti-anginal agent, which inhibits the abnormal late Na+ channel current resulting in decreased Na+/Ca++ overload. This inhibits after-depolarizations and reduces pulmonary vein firing, which have been implicated in the initiation and propagation of AF. Ranolazine increases atrial refractoriness and has no known pro-arrhythmic affects. Ranolazine is routinely given to patients with SHD. The ability of Ranolazine to terminate AF in man has not been described but if useful could be a safer PIP agent with application in the presence or absence of SHD. We describe our experience using oral Ranolazine to convert new or recurrent AF.

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Flecainide versus quinidine for conversion of atrial fibrillation to sinus rhythm

Cited by 174 publications

References 23 publications

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

The Conversion of Paroxysmal or Initial Onset Atrial Fibrillation with Oral Ranolazine: Implications for a New "Pill-In-Pocket" Approach in Structural Heart Disease

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