Atrial fibrillation: acute: propafenone was more effective than verapamil at cardioversion.

Clinical bottom line (level 1b)

  1. Patients with recent onset atrial fibrillation who received propafenone compared with verapamil were more likely to revert to sinus rhythm (NNT = 2 at 48 hours) .
  2. There was no clear difference in complications.
Weiner et al: Chest 1994; 105 (4): 1013-1016
Expires November 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: emergency department, acute hospital, Israel

50 patients (aged mean 67 years, ?% male) recent-onset atrial fibrillation (less than 2 weeks based on history and previous medical records)

Excluded if
  • congestive heart failure


    • Control Group: (n = 25, 22 analysed): verapamil 40 mg every 4 hours for 48 hours or until converted to sinus rhythm
    Experimental Group: (n = 25, 24 analysed): propafenone 150 mg every 4 hours for 48 hours or until converted to sinus rhythm

    92% followed for 48 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no sinus rhythm 48 hours 13
    (59.1%)    		 3
    (12.5%)    		 79%
    (36% to 93%)    		 46.6%
    (22.2% to 71.0%)    		 2
    (1 to 5)
    complications 48 hours 3
    (13.6%)    		 0
    (0.00%)    		 100%
    (75.8% to 100%)    		 13.6%
    (-0.70% to 28.0%)    		 7
    (NNT = 4 to infinity;
    NNH = 140 to infinity)

  • Complications were two patients with heart failure and one with embolic stroke.

    • Citation

    1. Weiner P, Ganam R, Ganem R, et al: Clinical course of recent-onset atrial fibrillation treated with oral propafenone. Chest 1994; 105 (4): 1013-1016
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient AF
    Intervention or Exposure propafenone
    Comparison verapamil
    Outcome sinus rhythm