Background: In the daily clinical practice, patients with atrial fibrillation (AF) lasting more than 48h (or not datable at all) are not uncommon. In long-lasting AF changes in electrophysiological features (electrical remodeling) can occur, resulting in a loss of sensibility to most antiarrhythmic drugs. There is strong evidence that the main mechanism involved in electrical remodeling is a global shortening in refractory period. To assess safety and efficacy of quinidine in pharmacological cardioversion of long-lasting AF, compared with propafenone and amiodarone. Methods and Results:Ninety consecutive patients with AF lasting more than 6 weeks were randomized to amiodarone (5mg\kg bolus, then 15mg\kg in 24h) , propafenone (2 mg\kg bolus then 0.007mg\kg for 2h), and quinidine (275mg of quinidine arabogalattan sulphate per os every 2h for 8h maximum) for pharmacologic cardioversion. All patients had been previously treated with adequate oral anticoagulation and had been submitted to transthoracic echocardiogram. The 3 groups of patients did not differ for baseline and echocardiographic characteristics. Sinus rhythm was restored in 16 patients treated with quinidine (53%), compared with 6 patients (20%) in the amiodarone and propafenone groups (p<0.01). No major adverse effect was reported during the treatment. Conclusions: Quinidine seems to be safe and effective in pharmacological cardioversion of long-lasting AF.
RCT Entities:
Background: In the daily clinical practice, patients with atrial fibrillation (AF) lasting more than 48h (or not datable at all) are not uncommon. In long-lasting AF changes in electrophysiological features (electrical remodeling) can occur, resulting in a loss of sensibility to most antiarrhythmic drugs. There is strong evidence that the main mechanism involved in electrical remodeling is a global shortening in refractory period. To assess safety and efficacy of quinidine in pharmacological cardioversion of long-lasting AF, compared with propafenone and amiodarone. Methods and Results: Ninety consecutive patients with AF lasting more than 6 weeks were randomized to amiodarone (5mg\kg bolus, then 15mg\kg in 24h) , propafenone (2 mg\kg bolus then 0.007mg\kg for 2h), and quinidine (275mg of quinidine arabogalattan sulphate per os every 2h for 8h maximum) for pharmacologic cardioversion. All patients had been previously treated with adequate oral anticoagulation and had been submitted to transthoracic echocardiogram. The 3 groups of patients did not differ for baseline and echocardiographic characteristics. Sinus rhythm was restored in 16 patients treated with quinidine (53%), compared with 6 patients (20%) in the amiodarone and propafenone groups (p<0.01). No major adverse effect was reported during the treatment. Conclusions: Quinidine seems to be safe and effective in pharmacological cardioversion of long-lasting AF.
Authors: Valentin Fuster; Lars E Rydén; David S Cannom; Harry J Crijns; Anne B Curtis; Kenneth A Ellenbogen; Jonathan L Halperin; Jean-Yves Le Heuzey; G Neal Kay; James E Lowe; S Bertil Olsson; Eric N Prystowsky; Juan Luis Tamargo; Samuel Wann; Silvia G Priori; Jean-Jacques Blanc; Andrzej Budaj; A John Camm; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; João Morais; Ady Osterspey; José Luis Zamorano; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffery L Anderson; Elliott M Antman; Sharon Ann Hunt; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel Journal: Rev Port Cardiol Date: 2007-04 Impact factor: 1.374
Authors: Christian Wolpert; Rainer Schimpf; Carla Giustetto; Charles Antzelevitch; Jonathan Cordeiro; Robert Dumaine; Ramon Brugada; Kui Hong; Urs Bauersfeld; Fiorenzo Gaita; Martin Borggrefe Journal: J Cardiovasc Electrophysiol Date: 2005-01
Authors: Bernhard Schwaab; Alexander Katalinic; Uta Maria Böge; Jürgen Loh; Peter Blank; Tatjana Kölzow; Dirk Poppe; Hendrik Bonnemeier Journal: Ann Noninvasive Electrocardiol Date: 2009-04 Impact factor: 1.468