title: 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.
authors.affiliation: Department of Cardiology, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan. kxk@fukuoka-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Kumagai
authors.forename: H
authors.initials: H
authors.lastname: Abe
authors.forename: T
authors.initials: T
authors.lastname: Hiraki
authors.forename: H
authors.initials: H
authors.lastname: Nakashima
authors.forename: Y
authors.initials: Y
authors.lastname: Oginosawa
authors.forename: H
authors.initials: H
authors.lastname: Ikeda
authors.forename: Y
authors.initials: Y
authors.lastname: Nakashima
authors.forename: T
authors.initials: T
authors.lastname: Imaizumi
authors.forename: K
authors.initials: K
authors.lastname: Saku
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000097:blood; D001281:Atrial Fibrillation / Q000097:blood / Q000188:drug therapy*; D002940:Circadian Rhythm; D004206:Disopyramide / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006339:Heart Rate; D006801:Humans; D007262:Infusions, Intravenous; D008012:Lidocaine / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; C042288:pilsicainide; D004206:Disopyramide