Atrial fibrillation: procainamide was no more effective than propafenone at cardioversion.
Clinical bottom line (level 1b-)
Patients in atrial fibrillation who received procainamide compared with propafenone had no clear difference in reversion to sinus rhythm.
There was no clear difference in the number of adverse events.
Mattioli et al:
Double-blinded ?concealed randomised
Setting: acute hospital, Italy
hospitalised with acute or chronic atrial fibrillation who failed to cardiovert spontaneously
known allergy to study drug
evidence of heart failure
recent MI or cardiac surgery within 3 months
cardiogenic shock or hypotension (systolic < 90 mmHg)
ECG evidence of ventricular pre-excitation, second or third degree AV block, previous diagnosis of sinus node disease
unstable hepatic or renal function
digitalis toxicity or hypokalaemia
on amiodarone, digoxin, calcium antagonists, beta-blockers
Note: All patients received quinidine 250 mg bd after cardioversion.
Control Group: (n = 38, 38 analysed):
100 mg bolus iv over 5 minutes; repeated up to a maximum dose of 1g
Experimental Group: (n = 38, 38 analysed):
2 mg/kg over 30 minutes
All patients had echocardiograms - those without mural thrombi received heparin for 48 hours, followed by anticoagulants for 4 weeks after cardioversion. Patients with AF >48 hours were anticoagulated for 3 weeks before and 4 weeks after cardioversion.
100% followed for
: hypotension, bradycardia, allergic dermatitis
||Time to outcome
| conversion to sinus rhythm
(NNT = 157 to infinity;
| adverse events
(NNT = 6 to infinity;
- The study is too small to show any clear difference in cardioversion between the two groups.
Contributor: Chris Ball and Clare Wotton,
D, et al:
propafenone versus procainamide for conversion of atrial fibrillation to sinus rhythm.
|Intervention or Exposure