12 Serial antiarrhythmic therapy reduces recurrences after cardioversion in chronic atrial fibrillation and atrial flutter Evaluable patients with chronic atrial fibrillation (n = 103) or atrial flutter (24), who underwent successful cardioversion to sinus rhythm, received serial prophylactic antiarrhthymic therapy. The patients progressed through 3 stages, depending on whether cardioversion was required because of arrhythmia recurrence. This is the first study' ... to suggest that such a strategy . •• may reduce the recurrence rate from 50% to approximately 35%' at 1 year. In stage I, patients received flecainide ('Tambocor') at a mean dose of 210 mg/day. 13 patients with atrial flutter received concomitant verapamil therapy. 34 and 31 % of patients were still in sinus rhythm at 1 and 2 years, respectively. Aecainide was withdrawn in 8 patients. 53 evaluable patients entered stage II; 12 went directly to stage III because of contraindications to stage II therapy. 39 patients received sotalol ('Sotacor'; mean dose 269 mg/day) and 14 received quinidine (,Kinidine Durette'; 1.5 g/day). 42% of patients were in sinus rhythm at both 1 and 2 years. Sotalol-related adverse effects included facilitation of atrioventricular nodal tachycardias, congestive heart failure, symptomatic sinus bradycardia, fatigue and diarrhoea + headaches in I patient each. 34 patients entered stage III and received amiodarone (mean dose 284 mg/day) for 4 weeks. Four patients converted to sinus rhythm after initiation of amiodarone therapy without the need for repeat cardioversion. 49 and 40% of patients were in sinus rhythm after 1 and 2 years, respectively. Amiodarone was withdrawn in 2 patients because of skin photoallergy. Age, number of previous arrhythmic episodes, total arrhythmic duration, and underlying mitral valve disease were predictors of intractibility despite serial treatment, and indicated patients in whom cardioversion should be avoided. Crijns HJ, Van Gelder IC, Van Gilst WH, Hillege H, Gosselink AM, et al. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrilation or atrial flutter. American Journal of Cardiology 68: 335-341, I Aug 1991 "" _ 17 Aug 1991 INPHARMA® ISSN 0156-2703/91/0817-0012/0$01.00/0 © Adi! Itltertlatiotlal Ltd

Serial antiarrhythmic therapy reduces recurrences after cardioversion in chronic atrial fibrillation and atrial flutter

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Serial antiarrhythmic therapy reduces recurrences after cardioversion in chronic atrial fibrillation and atrial flutter

Evaluable patients with chronic atrial fibrillation (n = 103) or atrial flutter (24), who underwent successful cardioversion to sinus rhythm, received serial prophylactic antiarrhthymic therapy. The patients progressed through 3 stages, depending on whether cardioversion was required because of arrhythmia recurrence. This is the first study' ... to suggest that such a strategy . •• may reduce the recurrence rate from 50% to approximately 35%' at 1 year.

In stage I, patients received flecainide ('Tambocor') at a mean dose of 210 mg/day. 13 patients with atrial flutter received concomitant verapamil therapy. 34 and 31 % of patients were still in sinus rhythm at 1 and 2 years, respectively. Aecainide was withdrawn in 8 patients.

53 evaluable patients entered stage II; 12 went directly to stage III because of contraindications to stage II therapy. 39 patients received sotalol ('Sotacor'; mean dose 269 mg/day) and 14 received quinidine (,Kinidine Durette'; 1.5 g/day). 42% of patients were in sinus rhythm at both 1 and 2 years. Sotalol-related adverse effects included facilitation of atrioventricular nodal tachycardias, congestive heart failure, symptomatic sinus bradycardia, fatigue and diarrhoea + headaches in I patient each.

34 patients entered stage III and received amiodarone (mean dose 284 mg/day) for ~ 4 weeks. Four patients converted to sinus rhythm after initiation of amiodarone therapy without the need for repeat cardioversion. 49 and 40% of patients were in sinus rhythm after 1 and 2 years, respectively. Amiodarone was withdrawn in 2 patients because of skin photoallergy.

Age, number of previous arrhythmic episodes, total arrhythmic duration, and underlying mitral valve disease were predictors of intractibility despite serial treatment, and indicated patients in whom cardioversion should be avoided. Crijns HJ, Van Gelder IC, Van Gilst WH, Hillege H, Gosselink AM, et al. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrilation or atrial flutter. American Journal of Cardiology 68: 335-341, I Aug 1991 ""

_ 17 Aug 1991 INPHARMA® ISSN 0156-2703/91/0817-0012/0$01.00/0 © Adi! Itltertlatiotlal Ltd