Efficacy of sequential antiarrhythmic treatment in sinus rhythm maintenance after successful electrocardioversion in patients with chronic non-valvular atrial fibrillation.
BACKGROUND
Sequential use of antiarrhythmic drugs may improve prognosis in chronic atrial fibrillation (AF). We conducted a prospective study of the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after a successful electrocardioversion (CV) in pts with chronic AF.


METHODS
58 pts (64.3 +/- 4.3 years old) with chronic AF underwent CV. After SR restoration (Group I) pts received one of the following antiarrhythmic drugs (Drug I): propafenone, sotalol or disopyramide. In case of arrhythmia recurrence, second CV was performed and pts received another drug from those mentioned above (Drug II). If treatment proved to be unsuccessful pts received amiodarone (Drug III) and third CV was attempted. After first unsuccessful CV (Group II) pts received a loading dose of amiodarone and another CV was attempted. In case of SR restoration amiodarone was administered continuously.


RESULTS
After 12 months 81% pts were on SR; 85% pts received amiodarone continuously. After 1 year 6 (10%) pts presented with SR treated with Drug I (median 71 days); Drug II proved to be ineffective in all patients (median 27 days). 28 pts continued to receive amiodarone (no median).


CONCLUSIONS
Sequential antiarrhythmic drug therapy improves arrhythmia prognosis in AF within a 12-month observation period. Amiodarone seems to be the most effective antiarrhythmic drug also in pts who required second CV proceeded by amiodarone treatment to restore SR.
Kosior
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D
Department of Internal Diseases and Cardiology, 1st Faculty of Medicine, Medical University in Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland.
Opolski
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G
Torbicki
A
A
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology* / Q000628:therapy; D002908:Chronic Disease; D004206:Disopyramide / Q000627:therapeutic use*; D004452:Echocardiography; D004554:Electric Countershock; D004562:Electrocardiography; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011405:Propafenone / Q000627:therapeutic use*; D013015:Sotalol / Q000627:therapeutic use*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D013015:Sotalol; D004206:Disopyramide; D000638:Amiodarone