Atrial fibrillation: no clear difference in cardioversion for amiodarone or propafenone.

Clinical bottom line (level 1b-)

  1. Patients with recent onset atrial fibrillation who receive propafenone compared with amiodarone are more likely to be in sinus rhythm at 3 hours (NNT = 3 at 3 hours) .
  2. Patients who received either amiodarone or propafenone were just as likely to be in sinus rhythm.
Treglia et al: Minerva Cardioangiologica 1994; 42: 293-297
Expires August 2003

The study

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

54 patients (aged range 39 to 78 years; mean 57, 57% female) with recent onset atrial fibrillation (<7 days)

Excluded if
  • thyrotoxic
  • renal or hepatic insufficiency
  • urgent cardioversion required
  • on antiarrhythmics
  • acute MI within last week
  • severe heart failure (NYHA class IV)


    • Note:
  • All patients received 12500 units of heparin every 12 hours.


    • Control Group: (n = 27, 27 analysed): propafenone; bolus of 2 mg/kg followed by an infusion of 5 mg/kg per day
    Experimental Group: (n = 27, 27 analysed): amiodarone: 5 mg/kg over one hour followed by an infusion of 10 mg/kg per day

    100% followed for 48 hours
    Outcome notes:
    • conversion to sinus rhythm : at 48 hours
    • sinus rhythm : at 3 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    conversion to sinus rhythm 48 hours 20
    (74.1%)    		 19
    (70.4%)    		 -5%
    (-32% to 32%)    		 -3.70%
    (-27.6% to 20.2%)    		 -27
    (NNT = 4 to infinity;
    NNH = 5 to infinity)
    sinus rhythm 3 hours 13
    (48.2%)    		 3
    (11.1%)    		 -77%
    (-28% to -93%)    		 -37.0%
    (-14.8% to -59.3%)    		 3
    (2 to 7)

    Comments

    1. The study is too small and too short to show which antiarrhythmic is clearly better.

    Citation

    1. Treglia A, Alfano C, Rossini E: Confronto tra propafenone ed amiodarone nella conversione al ritmo sinusale della fibrillazione atriale di recente insorgenza. Minerva Cardioangiologica 1994; 42: 293-297
    Contributor: Chris Ball and Bob Phillips, August 1999
    Reviewer:

    Clinical Question.
    Patient recent-onset atrial fibrillation
    Intervention or Exposure amiodarone
    Comparison propafenone
    Outcome cardioversion to sinus rhythm