A. Capucci et al., A CONTROLLED-STUDY ON ORAL PROPAFENONE VERSUS DIGOXIN PLUS QUINIDINE IN CONVERTING RECENT-ONSET ATRIAL-FIBRILLATION TO SINUS RHYTHM, International journal of cardiology, 43(3), 1994, pp. 305-313
Eighty-seven patients with recent onset atrial fibrillation (less-than
-or-equal-to 8 days) without clinical signs of heart failure were rand
omly allocated to one of the following treatments: (i) oral propafenon
e (600 mg as a loading dose followed after 8 h by 300 mg t.i.d.); (ii)
intravenous digoxin as acute scheme (up to 1.125 mg/24 h) followed af
ter 6 h by hydroquinidine chlorhydrate (total dose, 1350 mg); or (iii)
placebo. The patients were submitted to Holter monitoring for 48 h. R
esults: propafenone achieved higher successful conversion rates at 6,
12 and 24 h compared either with placebo (62% vs. 17%, 83% vs. 34%; 86
% vs. 55%; P < 0.01, respectively) or with digoxin at 6 h (62% vs. 38%
; P < 0.05) and digoxin plus quinidine at 12 h (83% vs. 48%; P < 0.05)
. At 48 h, a placebo conversion rate of 76% was observed with conseque
nt lack of any significant difference with the active treatments. Mean
conversion times within 48 h were 267 +/- 238 min for propafenone, 64
8 +/- 631 min for digoxin plus quinidine (P < 0.01 vs. propafenone) an
d 893 +/- 622 min for placebo (P < 0.001 vs. propafenone). Propafenone
and digoxin plasma levels were within the therapeutic range. Asymptom
atic phases of atrial flutter with greater-than-or-equal-to 2:1 atrio-
ventricular conduction ratio were observed during Holter monitoring, b
efore conversion to sinus rhythm, in four patients treated with propaf
enone, in one patient taking digoxin plus quinidine and in four patien
ts with placebo. One patient experienced syncope while standing up, 8
h after the beginning of propafenone treatment, due to a 1:1 atrial fl
utter with aberrant ventricular conduction. In conclusion, propafenone
as an oral loading dose followed by oral treatment is highly and quic
kly effective in converting recent onset atrial fibrillation to sinus
rhythm compared with placebo. Digoxin and digoxin plus quinidine, at t
he doses employed, had a lower success rate and more prolonged convers
ion times. The high rate of conversion to sinus rhythm during placebo
underlines the need for controlled studies in this subset of patients.