title: Efficacy and safety of sotalol versus quinidine for the maintenance of sinus rhythm after conversion of atrial fibrillation. SOCESP Investigators. The Cardiology Society of São Paulo.
abstract: To compare the efficacy and safety of sotalol and quinidine after conversion of atrial fibrillation (AF) of <6 months, a prospective multicenter trial enrolled 121 patients who were randomized to receive dl-sotalol (160 to 320 mg/day, 58 patients) or quinidine sulfate (600 to 800 mg/day, 63 patients). Patients with left ventricular ejection fraction of <0.40 or left atrial diameter >5.2 cm were excluded. After 6 months of follow-up, using the Kaplan-Meier method, the probabilities of success were comparable between sotalol (74%) and quinidine (68%), but recurrences occurred later with sotalol than with quinidine (69 vs 10 days, p <0.05). Four patients developed proarrhythmic events, 3 (5%) with sotalol and 1 (2%) with quinidine, which were all associated with diuretic therapy. In patients converted from recent-onset AF (< or = 72 hours), sotalol was more effective than quinidine (93% vs 64%, p = 0.01), whereas in chronic AF (> 72 hours), quinidine was more effective than sotalol (68% vs 33%, p <0.05). During recurrences, the ventricular rate was significantly reduced in patients taking sotalol (98 to 82 beats/min, p <0.05). Independent predictors of therapeutic success were recent-onset AF in the sotalol group (p <0.001) and absence of hypertension in the quinidine group (p <0.05). In conclusion, sotalol and quinidine have comparable efficacy and safety for the maintenance of sinus rhythm in the overall group. In recent-onset AF, sotalol was more effective, whereas in chronic AF, quinidine had a better result. Recurrences occurred later with sotalol when compared with quinidine. Because of proarrhythmia, these drugs should be used judiciously in patients on diuretic therapy.
authors.affiliation: Clinical Cardiac Electrophysiology Department of São Paulo Hospital, Federal University of São Paulo-Paulista School of Medicine, Brazil. eletrof@uol.com.br
authors.forename: A A
authors.initials: AA
authors.lastname: de Paola
authors.forename: H H
authors.initials: HH
authors.lastname: Veloso
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002908:Chronic Disease; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011802:Quinidine / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D013015:Sotalol / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D011802:Quinidine