PROSPECTIVE COMPARISON OF FLECAINIDE VERSUS SOTALOL FOR IMMEDIATE CARDIOVERSION OF ATRIAL-FIBRILLATION

This study sought to compare the efficacy and safety of intravenous fl ecainide and sotalol for immediate cardioversion of atrial fibrillatio n, We performed a prospective, randomized, single-blind, multicenter t rial, including 106 hemodynamically stable patients with atrial fib;il lation, stratified according to duration of the arrhythmia. Exclusion criteria included severely reduced left ventricular systolic function, recent antiarrhythmic therapy, and hypokalemia, Patients were randoml y assigned to receive either intravenous flecainide or intravenous sot alol, Trial medication was given at a dose of 1.5 mg/kg body weight (m aximum 150 mg). Overall, 28 of 54 patients (52%) given flecainide and 12 of 52 patients (23%) given sotalol converted to sinus rhythm during the first 2 hours after start of the infusion (p = 0.003). Multivaria te analysis confirmed that treatment allocation to flecainide, an arrh ythmia duration of less than or equal to 24 hours, higher plasma magne sium level at baseline, higher age for men, and lower age for women in dependently increases the probability of conversion. The frequency of adverse effects was not significantly different in the 2 treatment gro ups. (C) 1998 by Excerpta Medica, Inc.