Long-term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses.
OBJECTIVE
To compare the efficacy and safety of amiodarone and propafenone when used for the prevention of atrial fibrillation (AF) and maintenance of normal sinus rhythm in patients with refractory AF.


METHODS
Prospective, randomized, single-blind trial.


METHODS
Tertiary cardiac referral center.


METHODS
One hundred forty-six consecutive patients (72 men; mean age, 63 +/- 10 years [+/- SD]) with recurrent symptomatic AF.


METHODS
We studied 146 patients after restoration of sinus rhythm; patients were randomized to amiodarone, 200 mg/d, or propafenone, 450 mg/d. Follow-up clinical evaluations were conducted at the first, second, fourth, and sixth months, and at 3-month intervals thereafter. The proportion of patients relapsing to AF and/or experiencing side effects was calculated for each group using the Kaplan-Meier method. End point of the study was recurrence of AF or occurrence of side effects necessitating discontinuation of medication.


RESULTS
Of 146 patients, 72 received amiodarone and 74 received propafenone. The two groups were clinically similar. Of the 72 patients receiving amiodarone, AF developed in 25 patients, after an average of 9.8 months, compared to 33 of the 74 patients receiving propafenone after an average of 3.8 months. Twelve patients receiving amiodarone and 2 patients receiving propafenone had side effects necessitating withdrawal of medication while still in sinus rhythm.


CONCLUSIONS
Amiodarone tends to be more effective than propafenone in maintaining sinus rhythm in patients with AF, but this advantage is offset by a higher incidence of side effects.
Kochiadakis
George E
GE
Cardiology Department, University Hospital of Heraklion, Stavrakia, Heraklion, Crete, Greece. cardio@med.uoc.gr
Igoumenidis
Nikos E
NE
Hamilos
Michail I
MI
Tzerakis
Panos G
PG
Klapsinos
Nikos C
NC
Zacharis
Evangelos A
EA
Vardas
Panos E
PE
D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage*; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011336:Probability; D011405:Propafenone / Q000008:administration & dosage*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D000638:Amiodarone