Pretreatment with verapamil in patients with persistent or chronic atrial fibrillation who underwent electrical cardioversion

OBJECTIVES To evaluate, in a prospective and randomized fashion, the effica cy of a pretreatment with verapamil (V) in reducing recurrences of atrial f ibrillation (AF) after electrical cardioversion (C). BACKGROUND The increased vulnerability for AF recurrence is probably due to AF-induced changes in the electrophysiologic properties of the atria. This electrical remodeling seems to be due to intracellular calcium overload. METHODS One hundred seven patients with persistent or chronic AF underwent external and/or internal C. All patients received oral propafenone (P) (900 mg/day) three days before and during the entire period of follow-up (three months). In the first group, patients received only the P. In the second g roup, in adjunct to P, oral V (240 mg/day) was initiated three days before C and continued during the follow-up. Finally, in the third group, oral V w as administered three days before and continued only for three days after e lectrical C. RESULTS During the three months of follow-up, 23 patients (23.7%) had AF re currence. Mantel-Haenszel cumulative chi-square reached a significant level only when comparing AF free survival curves of group I versus group II and group III (chi-square 5.2 and 4, respectively; p < 0.05). Significantly, 1 5 (65.2%) AF relapses occurred during the first week after cardioversion wi th a higher incidence in group I (10/33 patients, 30.3%) than group II (2/3 4 patients, 5.9%; p = 0.01) and group III (3/30 patients, 10%; p = 0.04). CONCLUSIONS Six days of oral V administration centered on the C day, combin ed with P, significantly reduce the incidence of early recurrences of AF co mpared with P alone. CT Am Coil Cardiol 1999;34:810-4) (C) 1999 by the Amer ican College of Cardiology.