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Panos E. Vardas - One of the best experts on this subject based on the ideXlab platform.
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a comparative study of the efficacy and safety of procainamide versus Propafenone versus amiodarone for the conversion of recent onset atrial fibrillation
American Journal of Cardiology, 2007Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Gregory Chlouverakis, Maria E Marketou, Panos E. VardasAbstract:The appropriate treatment for the restoration of sinus rhythm in patients with atrial fibrillation (AF) of recent onset is still the subject of controversy. In this prospective, randomized, single-blind, placebo-controlled clinical study, we investigated the effectiveness and safety of procainamide, Propafenone, and amiodarone, administered intravenously, for the conversion of recent-onset AF. We enrolled 362 consecutive patients (183 men; age 34 to 86 years; mean 65+/-10) with AF duration of no >48 hours. Of these patients, 89 were given procainamide, 91 Propafenone, 92 amiodarone, and 90 placebo. Treatment was considered successful if conversion to sinus rhythm was achieved within the 24-hour study period. Baseline clinical characteristics were similar in the 4 groups. The treatment was successful in 61 of the 89 patients who received procainamide (68.53%; median time 3 hours), 73 of the 91 patients who received Propafenone (80.21%; median time 1 hour), 82 of the 92 patients who received amiodarone (89.13%; median time 9 hours), and 55 of the 90 patients who received placebo (61.11%; median time 17 hours; p<0.05 for all medicated groups vs placebo; p<0.05 for amiodarone and Propafenone vs procainamide). In conclusion, all 3 medications, when administered intravenously, are effective in the restoration of sinus rhythm in recent-onset AF. Amiodarone and Propafenone are more effective whereas procainamide and Propafenone are faster.
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long term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation amiodarone vs Propafenone both in low doses
Chest, 2004Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Panagiotis G. Tzerakis, Nikos C. Klapsinos, E Zacharis, Panos E. VardasAbstract:Study objectives To compare the efficacy and safety of amiodarone and Propafenone when used for the prevention of atrial fibrillation (AF) and maintenance of normal sinus rhythm in patients with refractory AF. Design Prospective, randomized, single-blind trial. Setting Tertiary cardiac referral center. Patients One hundred forty-six consecutive patients (72 men; mean age, 63 ± 10 years [± SD]) with recurrent symptomatic AF. Interventions We studied 146 patients after restoration of sinus rhythm; patients were randomized to amiodarone, 200 mg/d, or Propafenone, 450 mg/d. Follow-up clinical evaluations were conducted at the first, second, fourth, and sixth months, and at 3-month intervals thereafter. The proportion of patients relapsing to AF and/or experiencing side effects was calculated for each group using the Kaplan-Meier method. End point of the study was recurrence of AF or occurrence of side effects necessitating discontinuation of medication. Measurements and results Of 146 patients, 72 received amiodarone and 74 received Propafenone. The two groups were clinically similar. Of the 72 patients receiving amiodarone, AF developed in 25 patients, after an average of 9.8 months, compared to 33 of the 74 patients receiving Propafenone after an average of 3.8 months. Twelve patients receiving amiodarone and 2 patients receiving Propafenone had side effects necessitating withdrawal of medication while still in sinus rhythm. Conclusions Amiodarone tends to be more effective than Propafenone in maintaining sinus rhythm in patients with AF, but this advantage is offset by a higher incidence of side effects.
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Sotalol versus Propafenone for long-term maintenance of normal sinus rhythm in patients with recurrent symptomatic atrial fibrillation.
The American Journal of Cardiology, 2004Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Panagiotis G. Tzerakis, Nikos C. Klapsinos, Gregory Chlouverakis, Panos E. VardasAbstract:This prospective, randomized, single-blinded, placebo-controlled study compared the efficacy and safety of sotalol and Propafenone when used for long-term prevention of atrial fibrillation. For the long-term maintenance of normal sinus rhythm, Propafenone seems to be more effective than sotalol.
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amiodarone sotalol or Propafenone in atrial fibrillation which is preferred to maintain normal sinus rhythm
Pacing and Clinical Electrophysiology, 2000Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Maria E Marketou, Stavros I Chrysostomakis, Hercules E Mavrakis, Michail D Kaleboubas, Panos E. VardasAbstract:UNLABELLED This randomized study compared the efficacy and safety of amiodarone, Propafenone and sotalol in the prevention of atrial fibrillation. METHODS The population consisted of 214 consecutive patients (mean age 64 +/- 8 years, 106 men) with recurrent symptomatic atrial fibrillation. After restoration of sinus rhythm, patients were randomized to amiodarone (200 mg/day), Propafenone (450 mg/day) or sotalol (320 +/- 20 mg/day). Follow-up evaluations were conducted at 1, 2, 4 and 6 months, and at 3-month intervals thereafter. The proportion of patients developing recurrent atrial fibrillation and/or experiencing unacceptable adverse effects was measured in the three groups by the Kaplan-Meier method. RESULTS Recurrent atrial fibrillation occurred in 25 of the 75 patients treated with amiodarone compared to 51 of the 75 patients treated with sotalol and 24 of the 64 patients treated with Propafenone. Fourteen patients treated with amiodarone, five with sotalol, and one with Propafenone experienced adverse effects while in sinus rhythm, necessitating discontinuation of treatment (P < 0.001 for amiodarone and Propafenone vs sotalol). The difference between amiodarone and Propafenone was statistically nonsignificant when all events were included in the analysis. However, if the analysis was limited to recurrent atrial fibrillation events, amiodarone was more effective than Propafenone (P < 0.05). CONCLUSIONS Amiodarone and Propafenone were superior to sotalol in maintaining long-term normal sinus rhythm in patients with atrial fibrillation. Amiodarone tended to be superior to Propafenone, though its long-term efficacy was limited by adverse side effects.
George E. Kochiadakis - One of the best experts on this subject based on the ideXlab platform.
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a comparative study of the efficacy and safety of procainamide versus Propafenone versus amiodarone for the conversion of recent onset atrial fibrillation
American Journal of Cardiology, 2007Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Gregory Chlouverakis, Maria E Marketou, Panos E. VardasAbstract:The appropriate treatment for the restoration of sinus rhythm in patients with atrial fibrillation (AF) of recent onset is still the subject of controversy. In this prospective, randomized, single-blind, placebo-controlled clinical study, we investigated the effectiveness and safety of procainamide, Propafenone, and amiodarone, administered intravenously, for the conversion of recent-onset AF. We enrolled 362 consecutive patients (183 men; age 34 to 86 years; mean 65+/-10) with AF duration of no >48 hours. Of these patients, 89 were given procainamide, 91 Propafenone, 92 amiodarone, and 90 placebo. Treatment was considered successful if conversion to sinus rhythm was achieved within the 24-hour study period. Baseline clinical characteristics were similar in the 4 groups. The treatment was successful in 61 of the 89 patients who received procainamide (68.53%; median time 3 hours), 73 of the 91 patients who received Propafenone (80.21%; median time 1 hour), 82 of the 92 patients who received amiodarone (89.13%; median time 9 hours), and 55 of the 90 patients who received placebo (61.11%; median time 17 hours; p<0.05 for all medicated groups vs placebo; p<0.05 for amiodarone and Propafenone vs procainamide). In conclusion, all 3 medications, when administered intravenously, are effective in the restoration of sinus rhythm in recent-onset AF. Amiodarone and Propafenone are more effective whereas procainamide and Propafenone are faster.
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long term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation amiodarone vs Propafenone both in low doses
Chest, 2004Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Panagiotis G. Tzerakis, Nikos C. Klapsinos, E Zacharis, Panos E. VardasAbstract:Study objectives To compare the efficacy and safety of amiodarone and Propafenone when used for the prevention of atrial fibrillation (AF) and maintenance of normal sinus rhythm in patients with refractory AF. Design Prospective, randomized, single-blind trial. Setting Tertiary cardiac referral center. Patients One hundred forty-six consecutive patients (72 men; mean age, 63 ± 10 years [± SD]) with recurrent symptomatic AF. Interventions We studied 146 patients after restoration of sinus rhythm; patients were randomized to amiodarone, 200 mg/d, or Propafenone, 450 mg/d. Follow-up clinical evaluations were conducted at the first, second, fourth, and sixth months, and at 3-month intervals thereafter. The proportion of patients relapsing to AF and/or experiencing side effects was calculated for each group using the Kaplan-Meier method. End point of the study was recurrence of AF or occurrence of side effects necessitating discontinuation of medication. Measurements and results Of 146 patients, 72 received amiodarone and 74 received Propafenone. The two groups were clinically similar. Of the 72 patients receiving amiodarone, AF developed in 25 patients, after an average of 9.8 months, compared to 33 of the 74 patients receiving Propafenone after an average of 3.8 months. Twelve patients receiving amiodarone and 2 patients receiving Propafenone had side effects necessitating withdrawal of medication while still in sinus rhythm. Conclusions Amiodarone tends to be more effective than Propafenone in maintaining sinus rhythm in patients with AF, but this advantage is offset by a higher incidence of side effects.
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Sotalol versus Propafenone for long-term maintenance of normal sinus rhythm in patients with recurrent symptomatic atrial fibrillation.
The American Journal of Cardiology, 2004Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Panagiotis G. Tzerakis, Nikos C. Klapsinos, Gregory Chlouverakis, Panos E. VardasAbstract:This prospective, randomized, single-blinded, placebo-controlled study compared the efficacy and safety of sotalol and Propafenone when used for long-term prevention of atrial fibrillation. For the long-term maintenance of normal sinus rhythm, Propafenone seems to be more effective than sotalol.
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amiodarone sotalol or Propafenone in atrial fibrillation which is preferred to maintain normal sinus rhythm
Pacing and Clinical Electrophysiology, 2000Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Maria E Marketou, Stavros I Chrysostomakis, Hercules E Mavrakis, Michail D Kaleboubas, Panos E. VardasAbstract:UNLABELLED This randomized study compared the efficacy and safety of amiodarone, Propafenone and sotalol in the prevention of atrial fibrillation. METHODS The population consisted of 214 consecutive patients (mean age 64 +/- 8 years, 106 men) with recurrent symptomatic atrial fibrillation. After restoration of sinus rhythm, patients were randomized to amiodarone (200 mg/day), Propafenone (450 mg/day) or sotalol (320 +/- 20 mg/day). Follow-up evaluations were conducted at 1, 2, 4 and 6 months, and at 3-month intervals thereafter. The proportion of patients developing recurrent atrial fibrillation and/or experiencing unacceptable adverse effects was measured in the three groups by the Kaplan-Meier method. RESULTS Recurrent atrial fibrillation occurred in 25 of the 75 patients treated with amiodarone compared to 51 of the 75 patients treated with sotalol and 24 of the 64 patients treated with Propafenone. Fourteen patients treated with amiodarone, five with sotalol, and one with Propafenone experienced adverse effects while in sinus rhythm, necessitating discontinuation of treatment (P < 0.001 for amiodarone and Propafenone vs sotalol). The difference between amiodarone and Propafenone was statistically nonsignificant when all events were included in the analysis. However, if the analysis was limited to recurrent atrial fibrillation events, amiodarone was more effective than Propafenone (P < 0.05). CONCLUSIONS Amiodarone and Propafenone were superior to sotalol in maintaining long-term normal sinus rhythm in patients with atrial fibrillation. Amiodarone tended to be superior to Propafenone, though its long-term efficacy was limited by adverse side effects.
Bjorn C Knollmann - One of the best experts on this subject based on the ideXlab platform.
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efficacy and potency of class i antiarrhythmic drugs for suppression of ca2 waves in permeabilized myocytes lacking calsequestrin
Journal of Molecular and Cellular Cardiology, 2011Co-Authors: Eleonora Savio Galimberti, Bjorn C KnollmannAbstract:Abstract Ca 2+ waves can trigger ventricular arrhythmias such as catecholaminergic–polymorphic ventricular tachycardia (CPVT). Drugs that prevent Ca 2+ waves may have antiarrhythmic properties. Here, we use permeabilized ventricular myocytes from a CPVT mouse model lacking calsequestrin (casq2) to screen all clinically available class I antiarrhythmic drugs and selected other antiarrhythmic agents for activity against Ca 2+ waves. Casq2−/− myocytes were imaged in line-scan mode and the following Ca 2+ wave parameters analyzed: wave incidence, amplitude, frequency, and propagation speed. IC 50 (potency) and maximum inhibition (efficacy) were calculated for each drug. Drugs fell into 3 distinct categories. Category 1 drugs (flecainide and R-Propafenone) suppressed wave parameters with the highest potency (IC 50 50% maximum wave inhibition). Category 2 drugs (encainide, quinidine, lidocaine, and verapamil) had intermediate potency (IC 50 20–40 μM) and efficacy (20–40% maximum wave inhibition). Category 3 drugs (procainamide, disopyramide, mexiletine, cibenzoline, and ranolazine) had no significant effects on Ca 2+ waves at the highest concentration tested (100 μM). Propafenone was stereoselective, with R-Propafenone suppressing waves more potently than S-Propafenone (IC 50 : R-Propafenone 2 ± 0.2 μM vs. S-Propafenone 54 ± 18 μM). Both flecainide and R-Propafenone decreased Ca 2+ spark mass and converted propagated Ca 2+ waves into non-propagated wavelets and frequent sparks, suggesting that reduction in spark mass, not spark frequency, was responsible for wave suppression. Among all class I antiarrhythmic drugs, flecainide and R-Propafenone inhibit Ca 2+ waves with the highest potency and efficacy. Permeabilized casq2−/− myocytes are a simple in-vitro assay for finding drugs with activity against Ca 2+ waves. This article is part of a Special Issue entitled ‘Possible Editorial’.
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inhibition of cardiac ca2 release channels ryr2 determines efficacy of class i antiarrhythmic drugs in catecholaminergic polymorphic ventricular tachycardia
Circulation-arrhythmia and Electrophysiology, 2011Co-Authors: Hyun Seok Hwang, Can Hasdemir, Derek R Laver, Divya Mehra, Kutsal Turhan, Michela Faggioni, Huiyong Yin, Bjorn C KnollmannAbstract:Background— Catecholaminergic polymorphic ventricular tachycardia (CPVT) is caused by mutations in the cardiac ryanodine receptor (RyR2) or calsequestrin (Casq2) and can be difficult to treat. The class Ic antiarrhythmic drug flecainide blocks RyR2 channels and prevents CPVT in mice and humans. It is not known whether other class I antiarrhythmic drugs also block RyR2 channels and to what extent RyR2 channel inhibition contributes to antiarrhythmic efficacy in CPVT. Methods and Results— We first measured the effect of all class I antiarrhythmic drugs marketed in the United States (quinidine, procainamide, disopyramide, lidocaine, mexiletine, flecainide, and Propafenone) on single RyR2 channels incorporated into lipid bilayers. Only flecainide and Propafenone inhibited RyR2 channels, with the S-enantiomer of Propafenone having a significantly lower potency than R-Propafenone or flecainide. In Casq2−/− myocytes, the Propafenone enantiomers and flecainide significantly reduced arrhythmogenic Ca2+ waves at clinically relevant concentrations, whereas Na+ channel inhibitors without RyR2 blocking properties did not. In Casq2−/− mice, 5 mg/kg R-Propafenone or 20 mg/kg S-Propafenone prevented exercise-induced CPVT, whereas procainamide (20 mg/kg) or lidocaine (20 mg/kg) were ineffective (n=5 to 9 mice, P <0.05). QRS duration was not significantly different, indicating a similar degree of Na+ channel inhibition. Clinically, Propafenone (900 mg/d) prevented ICD shocks in a 22-year-old CPVT patient who had been refractory to maximal standard drug therapy and bilateral stellate ganglionectomy. Conclusions— RyR2 cardiac Ca2+ release channel inhibition appears to determine efficacy of class I drugs for the prevention of CPVT in Casq2−/− mice. Propafenone may be an alternative to flecainide for CPVT patients symptomatic on β-blockers.
Nikos E. Igoumenidis - One of the best experts on this subject based on the ideXlab platform.
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a comparative study of the efficacy and safety of procainamide versus Propafenone versus amiodarone for the conversion of recent onset atrial fibrillation
American Journal of Cardiology, 2007Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Gregory Chlouverakis, Maria E Marketou, Panos E. VardasAbstract:The appropriate treatment for the restoration of sinus rhythm in patients with atrial fibrillation (AF) of recent onset is still the subject of controversy. In this prospective, randomized, single-blind, placebo-controlled clinical study, we investigated the effectiveness and safety of procainamide, Propafenone, and amiodarone, administered intravenously, for the conversion of recent-onset AF. We enrolled 362 consecutive patients (183 men; age 34 to 86 years; mean 65+/-10) with AF duration of no >48 hours. Of these patients, 89 were given procainamide, 91 Propafenone, 92 amiodarone, and 90 placebo. Treatment was considered successful if conversion to sinus rhythm was achieved within the 24-hour study period. Baseline clinical characteristics were similar in the 4 groups. The treatment was successful in 61 of the 89 patients who received procainamide (68.53%; median time 3 hours), 73 of the 91 patients who received Propafenone (80.21%; median time 1 hour), 82 of the 92 patients who received amiodarone (89.13%; median time 9 hours), and 55 of the 90 patients who received placebo (61.11%; median time 17 hours; p<0.05 for all medicated groups vs placebo; p<0.05 for amiodarone and Propafenone vs procainamide). In conclusion, all 3 medications, when administered intravenously, are effective in the restoration of sinus rhythm in recent-onset AF. Amiodarone and Propafenone are more effective whereas procainamide and Propafenone are faster.
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long term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation amiodarone vs Propafenone both in low doses
Chest, 2004Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Panagiotis G. Tzerakis, Nikos C. Klapsinos, E Zacharis, Panos E. VardasAbstract:Study objectives To compare the efficacy and safety of amiodarone and Propafenone when used for the prevention of atrial fibrillation (AF) and maintenance of normal sinus rhythm in patients with refractory AF. Design Prospective, randomized, single-blind trial. Setting Tertiary cardiac referral center. Patients One hundred forty-six consecutive patients (72 men; mean age, 63 ± 10 years [± SD]) with recurrent symptomatic AF. Interventions We studied 146 patients after restoration of sinus rhythm; patients were randomized to amiodarone, 200 mg/d, or Propafenone, 450 mg/d. Follow-up clinical evaluations were conducted at the first, second, fourth, and sixth months, and at 3-month intervals thereafter. The proportion of patients relapsing to AF and/or experiencing side effects was calculated for each group using the Kaplan-Meier method. End point of the study was recurrence of AF or occurrence of side effects necessitating discontinuation of medication. Measurements and results Of 146 patients, 72 received amiodarone and 74 received Propafenone. The two groups were clinically similar. Of the 72 patients receiving amiodarone, AF developed in 25 patients, after an average of 9.8 months, compared to 33 of the 74 patients receiving Propafenone after an average of 3.8 months. Twelve patients receiving amiodarone and 2 patients receiving Propafenone had side effects necessitating withdrawal of medication while still in sinus rhythm. Conclusions Amiodarone tends to be more effective than Propafenone in maintaining sinus rhythm in patients with AF, but this advantage is offset by a higher incidence of side effects.
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Sotalol versus Propafenone for long-term maintenance of normal sinus rhythm in patients with recurrent symptomatic atrial fibrillation.
The American Journal of Cardiology, 2004Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Michail E. Hamilos, Panagiotis G. Tzerakis, Nikos C. Klapsinos, Gregory Chlouverakis, Panos E. VardasAbstract:This prospective, randomized, single-blinded, placebo-controlled study compared the efficacy and safety of sotalol and Propafenone when used for long-term prevention of atrial fibrillation. For the long-term maintenance of normal sinus rhythm, Propafenone seems to be more effective than sotalol.
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amiodarone sotalol or Propafenone in atrial fibrillation which is preferred to maintain normal sinus rhythm
Pacing and Clinical Electrophysiology, 2000Co-Authors: George E. Kochiadakis, Nikos E. Igoumenidis, Maria E Marketou, Stavros I Chrysostomakis, Hercules E Mavrakis, Michail D Kaleboubas, Panos E. VardasAbstract:UNLABELLED This randomized study compared the efficacy and safety of amiodarone, Propafenone and sotalol in the prevention of atrial fibrillation. METHODS The population consisted of 214 consecutive patients (mean age 64 +/- 8 years, 106 men) with recurrent symptomatic atrial fibrillation. After restoration of sinus rhythm, patients were randomized to amiodarone (200 mg/day), Propafenone (450 mg/day) or sotalol (320 +/- 20 mg/day). Follow-up evaluations were conducted at 1, 2, 4 and 6 months, and at 3-month intervals thereafter. The proportion of patients developing recurrent atrial fibrillation and/or experiencing unacceptable adverse effects was measured in the three groups by the Kaplan-Meier method. RESULTS Recurrent atrial fibrillation occurred in 25 of the 75 patients treated with amiodarone compared to 51 of the 75 patients treated with sotalol and 24 of the 64 patients treated with Propafenone. Fourteen patients treated with amiodarone, five with sotalol, and one with Propafenone experienced adverse effects while in sinus rhythm, necessitating discontinuation of treatment (P < 0.001 for amiodarone and Propafenone vs sotalol). The difference between amiodarone and Propafenone was statistically nonsignificant when all events were included in the analysis. However, if the analysis was limited to recurrent atrial fibrillation events, amiodarone was more effective than Propafenone (P < 0.05). CONCLUSIONS Amiodarone and Propafenone were superior to sotalol in maintaining long-term normal sinus rhythm in patients with atrial fibrillation. Amiodarone tended to be superior to Propafenone, though its long-term efficacy was limited by adverse side effects.
A Capucci - One of the best experts on this subject based on the ideXlab platform.
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safety of oral Propafenone in the conversion of recent onset atrial fibrillation to sinus rhythm a prospective parallel placebo controlled multicentre study
International Journal of Cardiology, 1999Co-Authors: A Capucci, Giovanni Quinto Villani, Daniela Aschieri, Massimo F PiepoliAbstract:Abstract Aim : Oral Propafenone is effective in restoring sinus rhythm however the proarrhythmic effects are still unknown. The Safety Antiarrhythmic Therapy Evaluation (SATE) trial was a prospective randomized placebo-controlled multicentre study which evaluated the safety of acute oral loading dose of Propafenone in patients with recent onset atrial fibrillation. Secondary end-points were to evaluate the effect of digitalis added to Propafenone in ventricular rate control and the efficacy of Propafenone alone or added to digitalis compared with efficacy of digitalis plus quinidine. Methods and results : 246 patients (126 male; 58±11 years) with atrial fibrillation of Conclusion : Propafenone in a single oral loading dose is safe and promptly effective in patients with recent onset atrial fibrillation.
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oral Propafenone to convert recent onset atrial fibrillation in patients with and without underlying heart disease a randomized controlled trial
Annals of Internal Medicine, 1997Co-Authors: Giuseppe Boriani, A Capucci, Mario Sanguinetti, Mauro Biffi, Giovanni Luca Botto, T Broffoni, Ida Rubino, S Della Casa, B MagnaniAbstract:Background: The effectiveness of oral Propafenone in converting recent-onset atrial fibrillation to sinus rhythm has been established by controlled trials. However, it is not clear whether the effectiveness of Propafenone is affected by the presence or absence of underlying heart disease. Objectives: To investigate the safety and effectiveness of oral Propafenone and the role of underlying heart disease. Design: Randomized, single-blind, controlled study. Setting: 3 teaching hospitals. Patients: 240 hospitalized patients with recent-onset atrial fibrillation. Intervention: Propafenone (one 600-mg oral dose) or placebo. Measurements: Conversion rates at 3 and 8 hours. Results: Propafenone was more effective than placebo for converting atrial fibrillation to sinus rhythm at 3 hours: Fifty-four of 119 patients (45%) receiving Propafenone and 22 of 121 patients (18%) receiving placebo had conversion (P < 0.001). It was also more effective at 8 hours: Ninety-one of 119 patients (76%) receiving Propafenone and 45 of 121 patients (37%) receiving placebo had conversion (P < 0.001). Subgroup analysis showed that among patients without heart disease, 78% of those receiving Propafenone and 56% of those receiving placebo converted to sinus rhythm within 8 hours (P = 0.02). In those with hypertension, the rate was 70% for those receiving Propafenone and 27% for those receiving placebo (P < 0.001); in patients with structural heart disease, the rate was 81% for those receiving Propafenone and 17% for those receiving placebo (P < 0.001). Conclusions: Oral loading of Propafenone was more effective than placebo for conversion to sinus rhythm within 8 hours and had a favorable safety profile. The rate of spontaneous conversion to sinus rhythm was higher in patients without structural heart disease; this finding has important implications for the assessment of drug effectiveness in recent-onset atrial fibrillation.
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Propafenone for conversion of recent onset atrial fibrillation a controlled comparison between oral loading dose and intravenous administration
Chest, 1995Co-Authors: Giuseppe Boriani, A Capucci, Tiziano Lenzi, Mario Sanguinetti, B MagnaniAbstract:Study objective To compare placebo vs two different regimens of Propafenone administration—intravenous administration or short-term oral loading—in converting recent-onset atrial fibrillation to sinus rhythm. Design Single-blind placebo-controlled study. Patients Eighty-seven patients with atrial fibrillation of recent onset (≤7 days' duration) admitted to the hospital without signs of organic heart disease (n=42) or with systemic hypertension without signs or symptoms of heart failure (n=45). The patients were assigned randomly to treatment with intravenous Propafenone (29 patients), oral Propafenone (29 patients), or placebo (29 patients). Interventions Administration of Propafenone intravenously (2-mg/kg bolus followed by 0.0078 mg/kg/min) or as short-term oral loading (600 mg orally single dose). Patients were submitted to Holter monitoring and conversion to sinus rhythm was evaluated at 1, 3, and 8 h. Results Conversion to sinus rhythm was obtained within 1 h in 28% with intravenous Propafenone, in 3% with oral Propafenone, and in 3% with placebo. At 3 h, the efficacy of intravenous Propafenone (41%) and of oral Propafenone (55%) were statistically superior to placebo (10% of conversions) and at 8 h either intravenous or oral Propafenone were effective in almost two thirds of the patients with a statistical difference vs placebo, whose efficacy was 24%. No major side effects were observed. Conclusions Propafenone as an oral loading dose is an efficacious and fast way of treating atrial fibrillation of recent onset and due to its simplicity of administration and safety can be preferred to the intravenous route. (CHEST 1995; 108:355-58)
