Atrial fibrillation: paroxysmal: no clear role for propafenone or flecainide.

Clinical bottom line (level 1b-)

Patients with paroxysmal atrial fibrillation who took propafenone compared with flecainide were not clearly more likely to stop therapy.
The effect on symptom-free months was unclear.

Aliot et al: American Journal of Cardiology 1996; 77: 66A-71A

Expires November 2001

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: multicentre, France

97 patients (aged mean 63 years, 53% male) paroxysmal episodes of AF or atrial flutter with disabling symptoms

Excluded if

<18 years

history of unstable angina, MI

heart surgery within two months

previous VT or chronic AF or flutter (lasting > 72 hours)

congestive heart failure

sinus dysfunction without pacemaker, high-degree AV block, anterior fascicle block

amiodarone within three months

Control Group: (n = 48, 48 analysed): flecainide 50 mg bd po increased every 4 days by 50 mg to a maximum of 300 mg/day
Experimental Group: (n = 49, 49 analysed): propafenone 300 mg bd po increased every 4 days by 300 mg to a maximum of 1200 mg/day

100% followed for 12 months

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
discontinued therapy	12 months	19 (39.6%)	26 (53.1%)	-34% (-108% to 13%)	-13.5% (-33.1% to 6.19%)	-7 (NNT = 16 to infinity; NNH = 3 to infinity)

No clear difference between the two groups in terms of attacks (reported as attacks per patient-months).

Citation

Aliot E, Denjoy I, the Flecainide AF French Study Group : Comparison of the safety and efficacy of flecainide versus propafenone in hospital out-patients with symptomatic paroxysmal atrial fibrillation/ flutter. American Journal of Cardiology 1996; 77: 66A-71A

Search Terms: Atrial Fibril* in Cochrane
Contributor: Chris Ball and Clare Wotton, November 2000
Reviewer:

_{Clinical Question.}

_Patient	_AF
_{Intervention or Exposure}	_propafenone
_Comparison	_flecainide
_Outcome	_{discontinuation of therapy}