Atrial fibrillation: paroxysmal: flecainide was more effective than verapamil for cardioversion.

Clinical bottom line (level 1b)

  1. Patients with an acute episode of paroxysmal atrial fibrillation who received flecainide compared with verapamil were more likely to revert to sinus rhythm (NNT = 2 at 60 minutes) .
Suttorp et al: American Journal of Cardiology 1989; 63: 693-696
Expires November 2004

The study

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

40 patients (aged range 23 to 79 years; mean 59, 80% male) atrial fibrillation or flutter lasting < 6 months, and a ventricular rate > 100 beats/min at rest

Excluded if
  • evidence of heart failure
  • concomitant therapy with anti-arrhythmics
  • conduction disturbances more than first-degree heart block, Wolff-Parkinson-White syndrome, sick sinus syndrome
  • acute MI
  • hyperthyroidism
  • left atrial enlargement with AF or flutter lasting > 2 days without appropriate anticoagulation
  • weight > 100 kg


    • Control Group: (n = 20, 20 analysed): verapamil iv 10 mg over 1 minute
    Experimental Group: (n = 20, 20 analysed): flecainide iv 2 mg/kg over 10 minutes

    100% followed for 60 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no sinus rhythm 60 minutes 19
    (95.0%)    		 6
    (30.0%)    		 68%
    (38% to 84%)    		 65.0%
    (42.8% to 87.2%)    		 2
    (1 to 2)

    Citation

    1. Suttorp MJ, Kingma H, Lie-A-Huen L, et al: Intravenous flecainide versus verapamil for acute conversion of paroxsymal atrial fibrillation or flutter to sinus rhythm. American Journal of Cardiology 1989; 63: 693-696
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient paroxysmal AF
    Intervention or Exposure flecainide
    Comparison verapamil
    Outcome reversion to sinus rhythm