Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm
Section snippets
Patients
This prospective, randomized, single-blind trial included all patients presenting at the emergency room with acute AF (≤48 hours duration). Patients were recruited during a period of 18 months. Criteria defining the onset of the arrhythmia included an abrupt, well-defined onset of symptoms, such as palpitations, chest discomfort, or dyspnea. AF was confirmed with a 12-lead electrocardiogram in all patients.
Patients were excluded for the following criteria: (1) uncertain or >48 hours duration of
Patient characteristics
Overall, 150 consecutive patients were enrolled in the trial. Gender was male in 70 cases (47%) and age was 60 ± 13 years. Median time from onset of symptoms to the start of therapy was 6 hours (range 1 to 48). Fifty patients were randomly assigned to each treatment group. Table 1lists the clinical characteristics of patients in each study group.
Conversion rate
Table 2lists conversion rates at 1, 8, and 12 hours. There was a significantly greater proportion of patients reverting to sinus rhythm in the
Major findings
The present study is the first to compare intravenous flecainide, propafenone, and amiodarone directly in patients with acute AF (onset within 48 hours). Our results show that flecainide is more effective than propafenone and amiodarone in converting acute AF to sinus rhythm after 12 hours of observation. This higher reversion rate with flecainide was present from the first hour of the study period when compared with amiodarone, and only after administering a second bolus when compared with
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2022, Comprehensive PharmacologyPharmacologic Cardioversion of Recent-Onset Atrial Fibrillation and Flutter in the Emergency Department: A Systematic Review and Network Meta-analysis
2020, Annals of Emergency MedicineCitation Excerpt :The network inconsistency may be explained by factors beyond the outlier treatment arms. Conceptual heterogeneity in potential effect modifiers (such as atrial fibrillation duration, left atrial size, drug dosing regimen, and timing of rhythm assessment) and our merging of intravenous and oral treatment arms for flecainide40,50,51,53 and propafenone40,42,51 likely contributed to inconsistency and may affect the generalizability of results. Study sample sizes were too small to control for significant effect modifiers; however, if more evidence becomes available, one could potentially conduct covariate-adjusted analysis to account for some heterogeneity.
Use of Flecainide for the Treatment of Atrial Fibrillation
2020, American Journal of CardiologyCitation Excerpt :Based upon a meta-analysis of studies comparing IV amiodarone with placebo and/or Class IC agents,64 unlike flecainide, the AF conversion rate with IV amiodarone administration was similar to placebo at 1 to 2 hours after administration, higher than placebo but lower than flecainide at 6 to 8 hours after administration, and only at 24 hours was the conversion rate with amiodarone comparable with the rates attained at 6 to 8 hours with flecainide.64 Shown in Figure 3 are conversion rates over time from 2 studies evaluating IV amiodarone and oral57 or IV flecainide.63 In an emergency room propensity score case-matched study comparing Class IC agents with amiodarone, higher AF conversion rates (73% vs 53%, p <0.05) combined with equivalent adverse event rates resulted in a lower hospital admission rate with Class IC drugs (27% vs 52%, p <0.05).65