Comparison of sotalol versus quinidine for maintenance of normal sinus rhythm in patients with chronic atrial fibrillation

Many clinicians choose sotalol for the prevention of recurrences of atrial fibrillation (AF) as an alternative to quinidine, which has been associated with an increase in long-term mortality, Using meta-analytic techniques, w e compared the effects on maintenance of sinus rhythm and mortality of comb ined groups of patients with chronic AF treated with sotalol, quinidine, or a control drug. Rates of conversion at 6 months and mortality were combine d for each group after performing sensitivity analysis to test for homogene ity. Bayesian estimates and corresponding 95% credibility intervals were co nstructed to compare the probabilities of achieving sinus rhythm and mortal ity among groups. A literature search revealed 4 sotalol studies, 6 quinidi ne studies, and 5 control studies that met inclusion criteria established a priori. The point estimates for maintaining normal sinus rhythm (at 6 mont hs) and corresponding credibility intervals for the 3 groups were sotalol 5 0% (range 42% to 58%), quinidine 53% (range 48% to 59%), and control 32% (r ange 26% to 39%). When combining and comparing mortality effects, the follo wing studies met the same inclusion criteria: 4 sotalol studies, 9 quinidin e studies, and 7 control studies. The point estimates and corresponding cre dibility intervals for mortality in the 3 groups were sotalol 2.2% (range 0 .6% to 4.8%), quinidine 3.0% (range 1.7% to 4.7%), and control 1.1% (range 0.3% to 2.4%). Sotalol and quinidine are comparable in their ability to mai ntain sinus rhythm of. 6 months (about 50%) and both agents are superior to control. There is a trend for both agents to increase mortality with long- term therapy. These data do not support choosing sotalol over quinidine as a safer alternative for preventing recurrences of chronic AF. (C) 1999 by E xcerpta Medico, Inc.