Single Oral Administration of Pilsicainide Versus Infusion of Disopyramide for Termination of Paroxysmal Atrial Fibrillation: A Multicenter Trial

Abstract

A single oral dose of pilsicainide (PLS) is effective in terminating acute‐onset atrial fibrillation (AF). However, the effectiveness of this single oral treatment has not been compared with the infusion of other antiarrhythmic drugs. The effects of a single oral dose of PLS on the termination of AF were compared with an infusion of disopyramide (DISO) in a multicenter trial. Seventy‐two patients with electrocardiographically confirmed, symptomatic, paroxysmal AF (< 48‐hour duration) were randomized to receive either a single 100‐ to 150‐mg dose of PLS versus a 2 mg/kg (maximum dose = 100 mg) infusion of DISO. Successful defibrillation was defined as termination of AF within 2 hours of drug administration. Conversion of AF to sinus rhythm was achieved within 2 hours in 29 of 40 patients (73%) treated with PLS, and in 18 of 32 patients (56%) treated with DISO (NS). The mean time to return of sinus rhythm was 60 ± 30 minutes in the PLS group versus 23 ± 18 minutes in the DISO group (P < 0.001). DISO was particularly effective in terminating nocturnal AF, whereas PLS had a stable circadian effect. PLS was significantly more effective than DISO between 6 am and 12 pm (64% vs 17%, P < 0.05). No adverse effect was observed in either group. In conclusion, a single oral dose of PLS was as effective as an infusion of DISO to restore sinus rhythm in patients with recent‐onset AF. PLS consistently terminated AF regardless of its time of onset.

Pharmacological Conversion of Persistent Atrial Fibrillation Into Sinus Rhythm With Oral Pilsicainide

“…Furthermore, a single oral dose of pilsicainide (100-150 mg) had a similar conversion rate to that of intravenous disopyramide (2 mg/kg up to a maximum dose of 100 mg) in patients with recent-onset AF. 15 Okishige et al determined the efficacy of pilsicainide (50 mg t.i.d.) and placebo in patients with long-lasting AF (>6 months) in whom electrical cardioversion had been scheduled.…”

“…14,15 Our previous study 16 showed that a 4-week oral treatment with pilsicainide terminated long-lasting (>6 months) AF in 21% of patients, which is a similar conversion rate to that of oral amiodarone in patients with persistent or chronic AF. 11 However, although conducted in a randomized and placebo-controlled fashion, the study had some drawbacks.…”

Hybrid Therapy With Pilsicainide and Pulmonary Vein Isolation for Atrial Fibrillation

“…12 Clinical studies have reported that this drug is highly effective at terminating AF. 13,14 In the dog, it has been reported that sodium-channel blocker suppresses focal discharges in the PV. 15,16 Moreover, in humans, Kumagai et al 17 demonstrated that pilsicainide prolonged the PV ERP and PV-LA conduction time and created pharmacological PV isolation just before the termination of AF because of the suppression of conductivity within the PVs and at the PV-LA junction.…”

A Simple In Vivo Atrial Fibrillation Model of Rat Induced by Transesophageal Atrial Burst Pacing

“…After the assessment of the basal control state, the animals were randomly assigned to two groups; namely, pilsicainide-or saline-administered groups. Then, the therapeutic dose of 1 mg / kg of pilsicainide (n = 6) or a vehicle saline (n = 6) was administered in a volume of 1 ml / kg through the femoral vein (4,5). Effects on the PR interval, QRS width, and QT interval of the ECG, heart rate, mean blood pressure, and Af duration were assessed 10, 20, 30, and 60 min after the drug administration.…”

“…In this report, we describe this new method, which can be completed within 10 min after the induction of anesthesia. Moreover, in order to test the model, we selected a pure sodium channel blocker pilsicainide, since in Japan, the drug has been most widely used against clinical paroxysmal Af attack (4,5).…”