Successful conversion of recent-onset atrial fibrillation by sequential administration of up to three antiarrhythmic drugs.
BACKGROUND
Short-term conversion attempt of recent-onset atrial fibrillation (AF) in the emergency room fails too often. Many patients and doctors still prefer pharmacological to electrical solutions in such cases.


OBJECTIVE
Sequential administration of up to 3 antiarrhythmic drugs of different classes of action (amiodarone, propafenone, and quinidine) may achieve conversion in such patients.


METHODS
One hundred and forty consecutive patients with recent-onset AF were transferred to the intensive cardiac care unit after a failed 2-h conversion attempt in the emergency room. First-line drug for conversion was continued up to a full dose, and was chosen by AF etiology, or in recurrent AF episodes, empirically. In nonresponders, the failed drug was replaced by a drug of another class, and if the second-line drug failed it was replaced by a drug of the third-line. Electrical cardioversion was the final solution for nonresponders.


RESULTS
Sixty percent of patients reached sinus rhythm by the first-line drug therapy, 34% by the second-line, and 4% by the third-line. Seventy-five percent of patients achieved conversion within 26 h, and 95% of patients achieved conversion within 40 h. Three patients were electrically cardioverted due to hemodynamical instability. Two episodes of Torsade de Pointes ventricular tachycardia were self-terminated.


CONCLUSIONS
Sequential usage of up to 3 antiarrhythmic drugs of different classes of action provides almost complete success in conversion of recent-onset AF in patients refractory to short-term conversion attempt in the emergency room.
Intensive Cardiac Care Department, Division of Cardiology, University Department of Medicine, Medical School Osijek, General Hospital Sveti Duh, Zagreb, Croatia. goran.milicevic1@zg.t-com.hr
Goran
G
Milicevic
Zeljka
Z
Gavranovic
Miro
M
Bakula
Vedran
V
Pazur
Branimir
B
Frank
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D004334:Drug Administration Schedule; D004554:Electric Countershock / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011405:Propafenone / Q000008:administration & dosage*; D011446:Prospective Studies; D011802:Quinidine / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D011802:Quinidine; D000638:Amiodarone