Atrial fibrillation, atrial flutter: chronic: sotalol was not clearly safer than quinidine

Clinical bottom line (level 1a-)

  1. Patients with chronic atrial fibrillation who took quinidine or sotalol were more likely to be in sinus rhythm at 6 months than patients who were not.
  2. There was no clear difference in mortality between patients on sotalol, quinidine or control medication.
  3. Sotalol was not clearly more effective than quinidine.
Southworth et al: American Journal of Cardiology 1999; 83: 1629-1632
Expires January 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: with chronic atrial fibrillation or flutter (> 72 hours)
  • Intervention: sotalol +/- cardioversion compared with quinidine +/- cardioversion
  • Outcome: death, normal sinus rhythm


    • Articles found in ?English using MEDline, 1985 to 1999 (search terms: atrial fibrillation or atrial flutter and sotalol or quinidine ) and searching reference lists of pertinent articles, and using data extracted from a previous systematic review.

    Selection criteria: see above
    Appraisal criteria: by 2 independent reviewers: criteria not stated
    Articles excluded if:
    • no data available at 3,6 or 12 months
    • therapy for post-operative AF or paroxysmal AF
    • used non-racemic or iv sotalol (or quinidine)
    • cross-over design


    9 studies involving quinidine, and 4 studies involving sotalol.
    Studies were not found to be heterogeneous.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    quinidine: normal sinus rhythm 6 months 161/304 53%
    (47% to 59%)    		 2
    (2 to 2)
    sotalol: normal sinus rhythm 6 months 78/155 50%
    (42% to 58%)    		 2
    (2 to 2)
    control: normal sinus rhythm 6 months 60/185 32%
    (26% to 39%)    		 3
    (3 to 4)
    quinidine: mortality ? 15/495 3.0%
    (1.5% to 4.5%)    		 33
    (22 to 66)
    sotalol: mortality ? 4/177 2.2%
    (0.6% to 4.8%)    		 44
    (21 to 167)
    control: mortality ? 4/365 1.1%
    (0.3% to 2.4%)    		 91
    (42 to 330)

    Comments

    1. Quinidine and sotalol were not clearly more likely to cause death than control, though there were too few studies to exclude a difference.
    2. Quinidine and sotalol were more effective than control at maintaining sinus rhythm at 6 months.

    Citation

    1. Southworth MR, Zarembski D, Viana M, et al: comparison of sotalol versus quinidine for maintenance of normal sinus rhythm in patients with chronic atrial fibrillation. American Journal of Cardiology 1999; 83: 1629-1632
    Search Terms: from 'Other Articles Noted' in ACP Journal Club, Nov-Dec 1999
    Contributor: Chris Ball and Clare Wotton, January 2000
    Reviewer:

    Clinical Question.
    Patient chronic atrial fibrillation or flutter
    Intervention or Exposure quinidine or sotalol
    Comparison control
    Outcome death, normal sinus rhythm