title: VErapamil plus antiarrhythmic drugs reduce atrial fibrillation recurrences after an electrical cardioversion (VEPARAF Study).
abstract: OBJECTIVE
  To evaluate the impact, on atrial fibrillation (AF) recurrences, of verapamil addition to a class IC or III antiarrhythmic drug in patients, with persistent AF, who underwent an electrical cardioversion (EC).
  
  
  RESULTS
  Three hundred sixty-three patients were randomized to receive four different pre-treatment protocols: oral amiodarone (group A), oral flecainide (group F), oral amiodarone plus oral verapamil (group A+V), oral flecainide plus oral verapamil (group F+V). Patients who showed an AF recurrence within 3 months were assigned to the alternative group and underwent a second EC after 48h. During 3 months of follow-up, 89 patients (27.5%) had an AF recurrence. By univariate analysis, verapamil reduced AF recurrences if added to amiodarone or flecainide (from 35% to 20%, P=0.004). Applying Cox proportional hazards regression model, only the younger age, the shorter duration of AF, and the use of verapamil were predictor of maintenance of sinus rhythm after cardioversion. In patients with primary AF recurrence, verapamil addition to group A and F patients, significantly decreased secondary AF recurrence rate as compared to group A+V and F+V patients who stopped the verapamil therapy (68% vs 88%, P=0.03).
  
  
  CONCLUSIONS
  The addition of verapamil to class IC or III antiarrhythmic drug significantly reduced the AF recurrences, that were more frequent in older patients and in patients with longer lasting AF; moreover, verapamil was effective in reducing the secondary AF recurrences, too.
authors.affiliation: Casa di Cura San Michele, Via Appia 176, 81024 Maddaloni (CE), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Simone
authors.forename: Michele
authors.initials: M
authors.lastname: De Pasquale
authors.forename: Carmine
authors.initials: C
authors.lastname: De Matteis
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Canciello
authors.forename: Michele
authors.initials: M
authors.lastname: Manzo
authors.forename: Luigi
authors.initials: L
authors.lastname: Sabino
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Alfano
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.forename: Andrea
authors.initials: A
authors.lastname: Campana
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Fabrizio
authors.forename: Dino Franco
authors.initials: DF
authors.lastname: Vitale
authors.forename: Pietro
authors.initials: P
authors.lastname: Turco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005424:Flecainide / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D000889:Anti-Arrhythmia Agents; D014700:Verapamil; D005424:Flecainide; D000638:Amiodarone