THE EFFICACY AND SAFETY OF INTRAVENOUS PROPAFENONE VERSUS INTRAVENOUSAMIODARONE IN THE CONVERSION OF ATRIAL-FIBRILLATION OR FLUTTER AFTER CARDIAC-SURGERY

Objective: The primary objective was to evaluate the efficacy of propa fenone compared with amiodarone in the reversion of atrial fibrillatio n or flutter. The secondary objective was the assessment pf the tolera nce of propafenone versus amiodarone. Design: An open, randomized tria l. Setting: A single university hospital. Participants: Forty patients who gave their informed consent. Interventions: These patients underw ent cardiac bypass surgery or aortic valvular replacement. For treatme nt of postsurgical arrhythmias, they either received intravenous propa fenone, 1 to 2 mg/kg in a 10-minute bolus, followed by an infusion of 420 mg in 24 hours, or amiodarone, 2.5 to 5 mg/kg, in a 10-minute bolu s followed by an infusion of 900 mg in 24 hours. Measurements and Main Results: Sinus rhythm was restored in 12 of 18 (67%) propafenone pati ents and in 17 of 22 (77%) amiodarone patients. If the early success t ime-limit had been fixed at 60 minutes. the proportion would have been 41% (7/17) for propafenone versus 14% (3/22) for amiodarone. and that difference is nearly significant (p = 0.07 Fisher's exact test). Howe ver. after 210 minutes, 50% of the propafenone patients regained sinus rhythm versus only 25% of the amiodarone patients. Hemodynamic parame ters improved with time in both groups without showing any statistical ly significant difference. Conclusions: The results suggest that propa fenone produces a more prompt effect in converting patients from atria l fibrillation or nutter to normal sinus rhythm. (C) 1996 by W.B. Saun ders Company