Flecainide versus ibutilide for immediate cardioversion of atrial fibrillation of recent onset.
OBJECTIVE
This study compared the efficacy and safety of intravenous flecainide and ibutilide for immediate cardioversion of atrial fibrillation (AF).


RESULTS
We conducted a prospective, randomised trial, including 207 patients with AF of recent onset (< or = 48 h). Flecainide was given over 20 min at a dose of 2 mg/kg body weight (maximum 200 mg), ibutilide was infused at a dose of 1 mg (or 0.01 mg/kg if less than 60 kg) over 10 min, followed by a 10 min observation period and an identical second dose if AF did not convert to sinus rhythm (SR). Treatment was considered successful if SR occurred within 90 min of starting medication. The conversion rates were 56.4% in patients given flecainide and 50.0% in patients given ibutilide (P=0.34). Multivariate analysis revealed that a lower age for women independently increased the probability of conversion. None of the other variables, including left atrial size, left ventricular systolic function, presence of left ventricular hypertrophy, plasma levels of potassium or magnesium at baseline, or concomitant use of digoxin, beta-blocker, diltiazem or verapamil were predictors of conversion. The frequency of adverse events was comparable in the two treatment groups.


CONCLUSIONS
There was no significant difference in the cardioversion efficacy or in the risk of adverse events between flecainide and ibutilide in patients with AF of recent onset. In patients without contraindications to both medications, the physician's choice has to be governed by other factors.
Department of Internal Medicine/Cardiology, Krankenhaus Barmherzige Schwestern, Seilerstätte 4, A-4020 Linz, Austria. johann.reisinger@bhs.at
Johann
J
Reisinger
Edmund
E
Gatterer
Wolfgang
W
Lang
Thetis
T
Vanicek
Geza
G
Eisserer
Theresia
T
Bachleitner
Christopher
C
Niemeth
Friedrich
F
Aicher
Wilhelm
W
Grander
Georg
G
Heinze
Peter
P
Kühn
Peter
P
Siostrzonek
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics; D001282:Atrial Flutter / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005424:Flecainide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016037:Single-Blind Method; D013449:Sulfonamides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide; D005424:Flecainide