Atrial fibrillation: paroxysmal: propafenone was more effective than quinidine at controlling attacks.

Clinical bottom line (level 1b)

  1. Patients with frequent attacks paroxsymal AF who took propafenone compared with quinidine were more likely to have a >75% reduction in their attacks (NNT = 2 at 3 months) .
  2. More patients were attack-free (NNT = 4 at 3 months) .
  3. Patients complained of fewer symptoms after propafenone.
  4. There was no clear difference in withdrawal rate due to adverse effects.
Lee et al: Journal of Internal Medicine 1996; 239: 253-260
Expires November 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: outpatient clinic, acute hospital, Taiwan

96 patients (aged mean 61 years, 69% male) paroxysmal AF and attacks occurring at least twice a week with a ventricular rate >100 beats/min, lasting >30 sec and < 48 hours (confirmed on event monitoring)

Excluded if
  • aged <15
  • child-bearing potential
  • severe congestive heart failure
  • sick sinus syndrome, 2nd or 3rd degree heart block, high-degree intraventricular conduction disorders
  • hypotension systolic bp < 90 mmHg
  • cardiogenic or septic shock with
  • significant renal, hepatic, neurological, haematological, endocrine or other systemic disease
  • severe COPD
  • myasthenia gravis
  • clinically significant electrolyte abnormalities
  • history of allergy to propafenone
  • on beta-blockers, calcium channel blockers, digoxin


    • Control Group: (n = 48, 46 analysed): quinidine 200 mg every 6 hours po, increased to 400 mg every 6 hours if no response
    Experimental Group: (n = 48, 46 analysed): propafenone 150 mg every 6 hours po, increased to 300 mg every 8 hours if no response

    100% followed for 3 months
    Outcome notes:
    • continuing attacks : (attack-free: confirmed by event monitor)

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    < 76% reduction in attacks 3 months 25
    (54.4%)    		 6
    (13.0%)    		 76%
    (47% to 89%)    		 41.3%
    (23.9% to 58.7%)    		 2
    (2 to 4)
    continuing attacks 3 months 36
    (78.3%)    		 23
    (50.0%)    		 36%
    (11% to 54%)    		 28.3%
    (9.53% to 47.0%)    		 4
    (2 to 10)
    withdrawal due to adverse effects 3 months 2
    (4.35%)    		 2
    (4.35%)    		 0%
    (-580% to 85%)    		 0%
    (-8.33% to 8.33%)    		 infinity
    (NNT = 12 to infinity;
    NNH = 12 to infinity)

    change in symptom score
    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    before and after propafenone 11.05
    (3.78)     		7.60
    (3.46)     		-3.45
    (-1.30 to -5.60)
    before and after quinidine 10.65
    (3.92)     		10.20
    (3.80)     		-0.45
    (-2.27 to 1.37)

  • Symptom score assessed by patient questionnaire- scored from 0 to 3 (0= no symptom; 3=severe). Symptoms assessed were palpitations, asthenia, rest dyspnoea, effort dyspnoea, dizziness, chest oppression, blurred vision and syncope.
  • symptom score: propafenone n=23; quinidine n=36.

    • Citation

    1. Lee SH, Chen SA, Chiang CE, et al: Comparisons of oral propafenone and quinidine as an initial treatment option in patients with symptomatic paroxysmal atrial fibrillation: a double-blind, randomized trial. Journal of Internal Medicine 1996; 239: 253-260
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient paroxysmal AF
    Intervention or Exposure propafenone
    Comparison quinidine
    Outcome reduction in attacks, side effects