Atrial fibrillation: paroxysmal: flecainide was better at cardioversion than procainamide.

Clinical bottom line (level 1b)

  1. Patients with paroxysmal atrial fibrillation who were given flecainide were more likely to be cardioverted than those given procainamide (NNT = 3 at 60 minutes) .
Madrid et al: European Heart Journal 1993; 14: 1127-1131
Expires December 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: general hospital, Spain

80 patients (aged mean 55 years, 63% male) paroxysmal atrial fibrillation for <24 hours

Excluded if
  • aged <75
  • slow ventricular rate (<100 beats per min)
  • clinical or radiological sign of acute heart failure
  • conduction disturbances
  • known sick sinus syndrome
  • severe hypoxaemia (oxygen partial pressure <55 mmHg)
  • acute ischaemic events
  • acute myocardial infarction
  • electrolyte alterations
  • atrial flutter
  • currently receiving antiarrhythmic drugs


    • Control Group: (n = 40, 40 analysed): procainamide 1 g over 30 minutes, followed by an infusion of 2 mg per minute over 1 hour
    Experimental Group: (n = 40, 40 analysed): flecainide 1.5 mg per kg body weight over 15 minutes, followed by 1.5 mg per kg over 1 hour

    100% followed for 60 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no cardioversion 60 minutes 15
    (37.5%)    		 3
    (7.50%)    		 80%
    (36% to 94%)    		 30.0%
    (12.9% to 47.1%)    		 3
    (2 to 8)

  • Adverse effects occurred with both treatments.

    • Citation

    1. Madrid AH, Moro C, Marin-Huerta F, et al: Comparison of flecainide and procainamide in cardioversion of atrial fibrillation. European Heart Journal 1993; 14: 1127-1131
    Contributor: Clare Wotton, December 2000
    Reviewer:

    Clinical Question.
    Patient atrial fibrillation
    Intervention or Exposure flecainide
    Comparison procainamide
    Outcome cardioversion