Atrial fibrillation: procainamide was no more effective than propafenone at cardioversion.

Clinical bottom line (level 1b-)

  1. Patients in atrial fibrillation who received procainamide compared with propafenone had no clear difference in reversion to sinus rhythm.
  2. There was no clear difference in the number of adverse events.
Mattioli et al: Clinical Cardiology 1998; 21: 763-766
Expires November 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, Italy

76 patients (aged mean 63, 73% male) hospitalised with acute or chronic atrial fibrillation who failed to cardiovert spontaneously

Excluded if
  • known allergy to study drug
  • aged <18
  • 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): procainamide 100 mg bolus iv over 5 minutes; repeated up to a maximum dose of 1g
    Experimental Group: (n = 38, 38 analysed): propafenone 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 48 hours
    Outcome notes:
    • adverse events : hypotension, bradycardia, allergic dermatitis

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    conversion to sinus rhythm 48 hours 26
    (68.4%)    		 18
    (47.4%)    		 -31%
    (-54% to -3%)    		 -21.1%
    (-42.7% to -0.64%)    		 -5
    (NNT = 157 to infinity;
    NNH = 2 to infinity)
    adverse events 48 hours 4
    (10.5%)    		 3
    (7.89%)    		 25%
    (-213% to 82%)    		 2.63%
    (-10.4% to 15.6%)    		 38
    (NNT = 6 to infinity;
    NNH = 10 to infinity)

    Comments

    1. The study is too small to show any clear difference in cardioversion between the two groups.

    Citation

    1. Mattioli AV, Lucchi GR, Vivoli D, et al: propafenone versus procainamide for conversion of atrial fibrillation to sinus rhythm. Clinical Cardiology 1998; 21: 763-766
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient atrial fibrillation
    Intervention or Exposure propafenone
    Comparison procainamide
    Outcome sinus rhythm