Pharmacological conversion of persistent atrial fibrillation into sinus rhythm with oral pilsicainide: pilsicainide suppression trial for persistent atrial fibrillation II.
BACKGROUND
The present study was conducted to determine the antiarrhythmic efficacy and safety of oral pilsicainide, a class Ic antiarrhythmic drug, in patients with persistent atrial fibrillation (AF).


RESULTS
One hundred and eight patients (mean age, 58.9 years) with AF lasting >or=48 h and <or=6 months were randomized to receive pilsicainide 50 mg t.i.d. (n=58) or placebo (n=50) for 2 weeks in a double-blinded fashion. All patients underwent appropriate anticoagulation therapy with warfarin for >or=3 weeks prior to the study enrolment or after verification of the absence of left atrial thrombi by transesophageal echocardiography. After 2 weeks of treatment, an electrocardiogram was recorded to determine whether sinus rhythm was restored. Sinus rhythm was restored in 22.4% of patients treated with pilsicainide and in 2% treated with placebo (p=0.002). Cardioversion was less likely to occur with oral pilsicainide when the AF duration exceeded 2 months or if the left atrial diameter exceeded 45 mm. There was no significant difference in the adverse cardiovascular event rate between the pilsicainide- and placebo-treated groups. One patient in the pilsicainide group developed an atrial flutter without any hemodynamic deterioration.


CONCLUSIONS
A 2-week oral administration of pilsicainide is well tolerated and moderately effective in converting persistent AF into sinus rhythm.
Okishige
Kaoru
K
Yokohama City Bay Red Cross Hospital, Yokohama, Japan. okishige@yo.rim.or.jp
Fukunami
Masatake
M
Kumagai
Koichiro
K
Atarashi
Hirotsugu
H
Inoue
Hiroshi
H
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000075202:Contraindications; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000187:drug effects; D012074:Remission Induction; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D014859:Warfarin; D008012:Lidocaine; C042288:pilsicainide