ORLANDO — Propafenone bested sotalol for long-term maintenance of sinus rhythm in patients with recurrent atrial fibrillation in a randomized, single-blind, placebo-controlled trial, Nikos E. Igoumenidis, M.D., reported at the annual meeting of the American College of Cardiology.
Based on the results of this unsponsored study, propafenone should be considered the drug of first choice for maintenance of sinus rhythm in patients with atrial fibrillation (AF), according to Dr. Igoumenidis of Heraklion (Greece) University Hospital.
The drug that is cited in the literature as being the most effective antiarrhythmic agent for preventing recurrent AF, amiodarone, is fraught with side effects that tend to limit its usefulness, he added.
Dr. Igoumenidis reported on 254 consecutive patients, 126 of them women, with recurrent symptomatic AF who were cardioverted to sinus rhythm and randomized to 450 mg/day of propafenone, 160–480 mg/day sotalol as tolerated, or placebo.
Of 85 patients in the sotalol group, 69 (81%) experienced relapse and/or side effects requiring drug discontinuation after a mean of 18 months. Of the 83 on placebo, 73 (88%) developed recurrent AF after a mean of 11 months.
In contrast, only 45 of 86 patients (52%) in the propafenone arm had relapse and/or discontinued treatment due to intolerable side effects after a mean of 26 months.
Three of the five patients who discontinued sotalol did so because of symptomatic bradycardia that arose during the loading phase. The other two patients dropped out due to severe dizziness, once again early in the course of treatment.
Seven other patients experienced significant side effects on sotalol that remitted when the dose was lowered, enabling them to continue on the medication.
Five patients quit taking propafenone because of side effects. All were early in therapy and in sinus rhythm at the time.
One developed unpleasant taste sensations, another had dizziness, and another experienced symptomatic bradycardia. The remaining two dropped out upon showing an increase in QRS duration or elevated liver enzymes.