Rate of conversion and recurrence after sotalol treatment in patients with direct current-refractory atrial fibrillation.
BACKGROUND
A number of patients with persistent atrial fibrillation (AF) will not have sinus rhythm (SR) restored by direct current (DC) cardioversion.


OBJECTIVE
In patients with DC-refractory AF, oral pretreatment with sotalol increases the success rate at DC cardioversion.


METHODS
Consecutive patients with persistent AF, refractory at a first DC cardioversion, were prospectively included. A comparative group of patients with AF not refractory at DC cardioversion was studied. Oral sotalol treatment was started after unsuccessful DC cardioversion and given at least 7 days before renewed cardioversion. Four weeks after cardioversion, an electrocardiogram was performed.


RESULTS
In all, 53 patients were enrolled in the study. Forty-three (81%) in the sotalol group regained sinus rhythm (SR): 10 (19%) of these converted pharmacologically and 33 (62%) after a second DC cardioversion; SR was never restored in 10 patients (19%). After 4 weeks, SR was maintained in 29 patients (67%). The comparative group included 132 patients and differed significantly from the DC-refractory patients only with regard to weight. After 4 weeks, SR was maintained by 50 patients (37%) in this group.


CONCLUSIONS
In patients with persistent AF refractory to DC cardioversion, oral pretreatment with sotalol results in a high rate of SR restoration, either pharmacologically or by DC cardioversion. Maintenance of SR at 4 weeks is of sufficient clinical relevance to consider this treatment option in patients with AF refractory to DC cardioversion.
Nergärdh
Anna
A
Department of Cardiology, Karolinska Institute at Stockholm South Hospital, Stockholm, Sweden. anna.nergardh@sodersjukhuset.se
Nordlander
Rolf
R
Frick
Mats
M
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D016022:Case-Control Studies; D004554:Electric Countershock; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D012008:Recurrence; D013015:Sotalol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D013015:Sotalol