Intravenous amiodarone vs propafenone for atrial fibrillation and flutter after cardiac operation

Abstract

The safety and efficacy of amiodarone and propafenone in converting atrial fibrillation or flutter after cardiac surgery were compared in a randomized double-blind trial. Eighty-four patients with sustained atrial tachyarrhythmias of more than 30 min' duration, stable hemodynamic status and neither preoperative atrial arrhythmias nor treatment with other antiarrhythmis drugs, were randomized to receive amiodarone (46 patients: 5 mg/kg over 15 min and then 15 mg/kg over the subsequent 24 h for non-converting) or propafenone (38 patients: 2 mg/kg over 15 in and then 10 mg/kg over the subsequent 24 h for non-converting). Nine of the 46 patients (19.5%) receiving amiodarone converted to sinus rhythm within 1 h following bolus injection compared with 17 of 38 patients (44.7%) treated with propafenone (P < 0.05). Within the 24 h study, 38 of 46 patients (82.6%) given amiodarone and 26 of 38 patients (68.4%) given propafenone were converted to sinus rhythm (P = NS). A significantly progressive reduction in ventricular response, already evident at 10th min from the start of treatment, was achieved in both groups of patients. Side effects occurred in six patients given propafenone (15.7%) and in five given amiodarone (10.8%) (P = NS). The two drugs were equally effective in converting postoperative atrial fibrillation and/or flutter after 24 h although propafenone was superior within the first hour.

Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University Hospital

“…Amiodarone was also the preferred therapy for patients with AF who were hemodynamically stable but had low blood pressure, based on evidence showing its safety in this situation. 9,23 The IV beta-blockers or calcium-channel blockers in such patients can cause further hypotension. For patients with depressed left ventricular function and those with ejection fraction < 20%, amiodarone was recommended as first-line therapy based on its lack of negative inotropic effects and low proarrythmia potential.…”

“…Two randomized trials assessed the efficacy of amiodarone compared with propafenone in reversing AF after cardiac surgery. 9,10 In the first study, 84 patients with sustained AF were randomized to receive IV amiodarone or IV propafenone. Within 24 h, 38 of 46 patients (82.6%) given amiodarone and 26 of 38 patients (68.4%) given propafenone converted to sinus rhythm, the difference was not significant.…”

Evidence-Based Analysis of Amiodarone Efficacy and Safety

“…In 1 of these studies, amiodarone and flecainide had similar rates of conversion. 70 Two studies of intravenous amiodarone and propafenone in postoperative AF of 40 and 84 patients, respectively, observed little difference between drugs, although there was a small trend in each study in favor of amiodarone at 24 hours with conversion rates of 67% versus 77% (PϭNS) 75 and 68% versus 83% (PϭNS). 76 Interestingly, in both studies, early (1 hour) conversion rates were significantly better with propafenone, suggesting a more delayed onset of action with amiodarone.…”

Intravenous amiodarone in intensive care

“…Di Biasi et al [34] compared amiodarone with propafenone in 84 patients with atrial fibrillation or flutter after cardiac surgery. They found that conversion rates at 1 h (19.5 % vs 44.7 %) were better with propafenone, but that by 24 h amiodarone was superior (82.6 % vs 68.4 %).…”