Atrial fibrillation: chronic: no clear role for propafenone before DC cardioversion.

Clinical bottom line (level 1b)

  1. Patients with chronic atrial fibrillation who took propafenone before DC cardioversion were not clearly more likely to have successful DC cardioversion.
  2. Patients given propafenone were more likely to revert to sinus rhythm (NNT = 5 at 48 hours) .
  3. Patients were less likely to have frequent premature atrial complexes (NNT = 3 at 10 minutes) , but more likely to have sinus node disturbances (NNH = 6 at 10 minutes) .
Bianconi et al: Journal of the American College of Cardiology 1996; 28 (3): 700-706
Expires November 2004

The study

Single-blinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, Italy

100 patients (aged mean 65 years, 54% male) atrial fibrillation for > 1 month scheduled for DC cardioversion

Excluded if
  • bifascicular block
  • mean daytime ventricular rate < 80 beats/min off digoxin or other drugs affecting AV node conduction
  • sinus node dysfunction (bradycardia = 50, sinus pauses or sinoatrial block)
  • uncontrolled hypothyroidism
  • major hepatic or renal dysfunction
  • clinical signs of cardiac or respiratory insufficiency
  • received class I, III or IV antiarrhythmic within 5 half-lives or amiodarone within 3 months


    • Control Group: (n = 51, 51 analysed): placebo- vitamin B1
    Experimental Group: (n = 49, 49 analysed): propafenone
    Patients still in AF after 48 hours underwent DC cardioversion, and received propafenone 750 mg po daily.
    100% followed for 48 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    required DC cardioversion 0 minutes 42
    (82%)    		 38
    (78%)    		 6%
    (-15% to 23%)    		 -4.80%
    (-10.9% to 20.5%)    		 21
    (NNT = 9 to infinity;
    NNH = 5 to infinity)
    no reversion to sinus rhythm 48 hours 24
    (47.1%)    		 13
    (26.5%)    		 44%
    (2% to 67%)    		 20.5%
    (2.08% to 39.0%)    		 5
    (3 to 48)
    sinus node disturbance 10 minutes 3
    (5.88%)    		 11
    (22.5%)    		 -282%
    (-1186% to -13%)    		 -16.6%
    (-29.9% to -3.22%)    		 -6
    (-31 to -3)
    frequent atrial premature complexes 10 minutes 22
    (43.1%)    		 7
    (14.3%)    		 67%
    (30% to 84%)    		 28.9%
    (12.1% to 45.6%)    		 3
    (2 to 8)

    Citation

    1. Bianconi L, Mennuni M, Lukic V, et al: Effects of oral propafenone administration before electrical cardioversion of chronic atrial fibrillation: a placebo-controlled study. Journal of the American College of Cardiology 1996; 28 (3): 700-706
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient chronic atrial fibrillation
    Intervention or Exposure propafenone before cardioversion
    Comparison placebo
    Outcome cardioversion