Skip to main content
SpringerLink
Log in

Intravenous propafenone: Efficacy and safety in the conversion to sinus rhythm of recent onset atrial fibrillation—A single-blind placebo-controlled study

  • Antiarrhythmic Agent
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Summary

The effectiveness of intravenous propafenone for conversion to sinus rhythm (SR) of paroxysmal atrial fibrillation (AF), lasting less than 7 days, was evaluated with a single-blind, randomized, placebo-controlled study, given the possible spontaneous conversion of this arrhythmia. Group 1 (98 patients) received intravenous propafenone (2 mg/kg iv over 10 minutes followed by 0.007 mg/kg/min); and group 2 (84 patients) received intravenous placebo (0.9% saline solution). The infusion was continued until restoration of SR but no longer than 24 hours. Eight-nine patients (90.8%) received propafenone and 27 patients (32%) receiving placebo were converted to SR (p<0.005). The mean conversion time was 2.46±2.59 hours in group 1 and 17.15±5.78 hours in group 2 (p<0.005). In patients treated with propafenone, conversion of SR mostly occurred in the first 4 hours (86.5%), considered to be the optimal infusion time in our experience. In both groups, the left atrial size was significantly larger in nonconverted than in converted patients. Similarly, the duration of the arrhythmia was significantly longer in nonconverted patients. In nonconverted patients, the mean ventricular rate decreased from 143±beats/min to 101±18 beats/min after propafenone and from 135±19 beats/min to 199 ±16 beats/min after placebo (group 1 vs. group 2: p<0.005). Two episodes of sinus standstill (3.4 and 3.8, seconds, respectively) occurred at SR restoration obtained with propafenone. Intravenous propafenone is an effective, safe, and usually rapid drug for AF treatment. Moreover, it produces a real and significant reduction in the mean ventricular rate in nonconverted patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. DeSilva RA, Graboys TB, Podrid PJ, Lown B. Cardioversion and defibrillation.Am Heart J 1980;100:881–895.

    PubMed  Google Scholar 

  2. Bazett HC. An analysis of the time-relation of electrocardiograms.Heart 1920;7:353–370.

    Google Scholar 

  3. Bryson HM, Palmer KJ, Langtry HD, Fitton A. Propafenone. A reappraisal of its pharmacology, pharmacokineties and therapeutic use in cardiac arrhythmias.Drugs 1993;45: 85–130.

    PubMed  Google Scholar 

  4. Schlepper M. Propafenone, a review of its profile.Eur Heart J 1987;8(Suppl A):27–32.

    Google Scholar 

  5. Wang J, Bourne GW, Wang Z, Villemaire C, Talajie M, Nattel S. Comparative mechanisms of antiarrhythmic drug action in experimental atrial fibrillation. Importance of usedependent effects of refractoriness.Circulation 1993;88: 1030–1044.

    PubMed  Google Scholar 

  6. Wang ZG, Pellettier LC, Talajic M, Nattel S. Effects of flecainide and quinidine on human atrial action potentials. Role of rate-dependence and comparison with guinea pig, rabbit and dog tissues.Circulation 1990;82:274–288.

    PubMed  Google Scholar 

  7. Capucci A, Gubelli S, Carini G, Fabretti L, Magnani B. Pharmacologic cardioversion with propafenone of stable atrial fibrillation of recent onset.G Ital Cardiol 1987;17: 975–982.

    PubMed  Google Scholar 

  8. Bianconi L. Boccadamo R, Pappalardo A, Gentili C, Pistolese M. Effectiveness of intravenous propafenone for conversion of atrial fibrillation and flutter of recent onset.Am J Cardiol 1989;64:335–338.

    PubMed  Google Scholar 

  9. Bracchetti D, Palmieri M. Safety and effectiveness of intravenous propafenone in cardioversion of recent onset atrial fibrillation.G Ital Cardiol 1992;22(Suppl 1):186.

    Google Scholar 

  10. Hamill SC, McLaran CJ, Wood DL, Osborn MJ, Gersh BJ, Holmes DR. Double-blind study of intravenous propafenone for paroxysmal superventricular reentrant tachycardia.J Am Coll Cardiol 1987;9:1364–1368.

    PubMed  Google Scholar 

  11. Assay ME. Atrial fibrlilation. In: Rakol RE, ed.Conn's Current Therapy, Philadelphia: WB Saunders, 1988:103.

    Google Scholar 

  12. Blazing MA, Morria JJ. Atrial fibrilletion: Conventional wisdom reappraised.Heart Dis Strole 1992;1:78–84.

    Google Scholar 

  13. Cowan JC. Antiarrhythmic drugs in the management of atrial fibrillation.Br Heart J 1993;70:304–306.

    PubMed  Google Scholar 

  14. Clark A, Cotter L. Cardioversion in atrial fibrillation.Br J Hosp Med 1993;49:256–261.

    PubMed  Google Scholar 

  15. Weiner P, Bassan MM, Jarehowsky J, Iusin S, Plavnick I. Clinical course of acute fibrillation treated with rapid digitalization.Am Heart J 1983;105:223–227.

    PubMed  Google Scholar 

  16. Falk RH, Knowlton AA, Bernard SA, Gotlieb NE, Battinelli NJ. Digoxin for converting recent-onset atrial fibrillation to sinus rhythm. A randomized double-blind trial.Ann Intern Med 1987;106:503–506.

    PubMed  Google Scholar 

  17. Tommaso C, McDonough T, Parker M, Talano JV. Atrial fibrillation and flutter: Immediate control and conversion with intravenously administered verapamil.Arch Intern Med 1983;143:877–881.

    PubMed  Google Scholar 

  18. Shenasa M, Kus T, Fromer M, LeBlane RA, Dubue M, Nadeau R. Effect of intravenous and oral calcium antagonists (diltiazem and verapamil) on sustenance of atrial fibrillation.Am J Cardiol 1988;62:403–407.

    PubMed  Google Scholar 

  19. Kingma JH, Suttorp MJ. Acute pharmacologic conversion of atrial fibrillation and flutter: The role of flecainide, propafenone, and verapamil.Am J Cardiol 1992;70:56A-60A.

    PubMed  Google Scholar 

  20. Hurst JW, Paulk EA, Proctor HD, Schlant RC. Management of patients with atrial fibrillation.Am J Med 1964;37: 728–741.

    PubMed  Google Scholar 

  21. Pascale LR, Bernstein LM, Schoolman H, Foley EF. Intravenous procainamide in the treatment of cardiac arrhythmias.Am Heart J 1954;48:110–122.

    PubMed  Google Scholar 

  22. Fenster PE, Comess KA, Marsh R, Katzemberg C, Hager WD. Conversion of atrial fibrillation to sinus rhythm by acute intravenous procainamide infusion.Am Heart J 1983; 106:501–504.

    PubMed  Google Scholar 

  23. Gavaghan TP, Fenely MP, Campbell TJ, Morgan JJ, Atrial tachyarrhythmias after cardiac surgery: Results of disopyramide therapy.Aust N Z J Med 1985;15:27–32.

    PubMed  Google Scholar 

  24. Faniel R, Shoenfeld PH. Efficacy of intravenous amioarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients.Eur Heart J 1983;4: 180–185.

    PubMed  Google Scholar 

  25. Strasberg B, Arditti A, Sclarowsky S, Lewin RF, Buimovici B, Agmon J. Efficacy of intravenous amiodarone in the management of paroxysmal or new atrial fibrillation with fast ventricular response.Int J. Cardiol 1985;7:47–55.

    PubMed  Google Scholar 

  26. Holmes B, Heel RC. Flecainide: A preliminary review of its pharmacodynamic properties and therapeutic efficacy.Drugs 1985;29:1–33.

    Google Scholar 

  27. Donovan KD, Dobb GJ, Coombs LJ, Weekes JN, Murdock CJ, Clarke GM. Reversion of recent-onset atrial fibrillation to sinus rhythm by intravenous flecainide.Am J Cardiol 1991;67:137–141.

    PubMed  Google Scholar 

  28. Suttorp MJ, Kingma JH, Jessurun ER, Lie-A-Huen L, van Hemel NM, Lie KI. The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm.J Am Coll Cardiol 1990;16: 1722–1727.

    PubMed  Google Scholar 

  29. Murdoek CJ, Kyles AE, Yeung-Lai-Wah JA, Qi A, Vorderbrugge S, Kerr CR. Atrial flutter in patients treated for atrial fibrillation with propafenone.Am J Cardiol 1990;66: 755–757.

    PubMed  Google Scholar 

  30. Van Gelder IC, Crijns HJ, Van Gilst WH, De Langen CD, Van Wijk LM, Lie KI. Effects of flecainide on the atrial defibrillation threshold.Am J Cardiol 1989;63:112–114.

    PubMed  Google Scholar 

  31. Bertini G, Conti A, Fradella G, et al. Propafenone verus amiodarone in field treatment of primary atrial tachydysrhythmias.Emerg Med 1990;8:15–20.

    Google Scholar 

  32. Connolly SJ, Mulji AS, Hoffert DL, Davis C, Shregge BW. Randomized placebo-controlled trial of propafenone for treatment of atrial tachyarrhythmias after cardiac surgery.J Am Coll Cardiol 1987;10:1145–1148.

    PubMed  Google Scholar 

  33. Gentili C, Giordano F, Alois A, Massa E, Bianconi L. Efficacy of intravenous propafenone in acute atrial fibrillation complicating open-heart surgery.Am Heart J 1992;123: 1225–1228.

    PubMed  Google Scholar 

  34. Goy JJ, Kaufman U, Kappenberger L, Sigwart U. Restoration of sinus rhythm with flecainide in patients with atrial fibrillation.Am J Cardiol 1988;62:38D-40D.

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Francesco Bellandi

    Present address: , Via delle Bartoline n.2, 50041, Calenzano, Florence, Italy

Authors and Affiliations

  1. Second Divisione di Medicina, Ospedale Misericordia e Dolce, Prato, Italy

    Francesco Bellandi & Fabrizio Cantini

  2. First Divisione di Medicina, Ospedale Misericordia e Dolce, Prato, Italy

    Massimo Di Natale

  3. Clinica Medica I°, University of Florence, Italy

    roberto Piero Dabizzi

Authors
  1. Francesco Bellandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. roberto Piero Dabizzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabrizio Cantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Massimo Di Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Niccoli
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bellandi, F., Dabizzi, r.P., Cantini, F. et al. Intravenous propafenone: Efficacy and safety in the conversion to sinus rhythm of recent onset atrial fibrillation—A single-blind placebo-controlled study. Cardiovasc Drug Ther 10, 153–157 (1996). https://doi.org/10.1007/BF00823593

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00823593

Key words

Search

Navigation