Department of Cardiology, Warsaw Medical University, Warszawa, Poland.
Cardiol J. 2009;16(6):521-7.
A prospective, randomized study was conducted to evaluate the efficacy and tolerability of oral propafenone and quinidine for the conversion of paroxysmal atrial fibrillation (AF).
Eighty one consecutive patients (female/male 46/35; mean age 64.0 +/- 11.6), admitted to hospital with AF lasting no longer than 48 hours, were randomized in terms of their pharmacological therapy. Forty three patients (55%) were randomly assigned to Group I and received propafenone 600 mg orally as the initial therapy, with an additional dose of 300 mg after eight hours, if the sinus rhythm had not been restored by then. Thirty eight patients (45%) (Group II) received 1 mg digoxin IV followed by an oral loading of quinidine (400 mg followed by 200 mg every two hours).
The conversion rate assessed after 24 hours was the same in both groups (Gr. I vs. Gr. II: 90.7 vs. 91.4%), with the same number of mild side effects (Gr. I vs. Gr. II: 37.2% vs. 45.7%). No life-threatening adverse events were reported. Propafenone achieved a higher efficacy rate during the first eight hours (83.3 vs. 54.3%; p = 0.01), with a significantly shorter time required to sinus rhythm recovery throughout the study period, with a median time of 165 min (95% confidence interval 120-278) vs. 360 min (95% confidence interval 298-650; p < 0.05). There was some indication of greater effectiveness of propafenone than quinidine in early sinus rhythm restoration in patients with: no structural heart disease, in those with an AF duration shorter than 12 hours, and in patients with an ejection fraction > 55%.
Although both drugs revealed the same effectiveness, the conversion to sinus rhythm in the group treated with propafenone was observed more quickly despite the longer paroxysmal AF episode duration.
一项前瞻性、随机研究评估了口服普罗帕酮和奎尼丁转复阵发性心房颤动（AF）的疗效和耐受性。
81 例连续患者（女性/男性 46/35；平均年龄 64.0 ± 11.6），因持续不超过 48 小时的 AF 入院，根据药物治疗随机分组。43 例（55%）患者随机分为 I 组，接受普罗帕酮 600mg 口服，初始治疗，如果窦性心律未恢复，则 8 小时后再加用 300mg。38 例（45%）（II 组）患者给予 1mg 地高辛静脉注射，然后口服奎尼丁（400mg 后每 2 小时 200mg）。
24 小时后评估的转复率在两组间相同（I 组与 II 组：90.7% vs. 91.4%），轻度副作用的数量相同（I 组与 II 组：37.2% vs. 45.7%）。无危及生命的不良事件报告。普罗帕酮在头 8 小时内的疗效更高（83.3% vs. 54.3%；p = 0.01），恢复窦性心律所需时间明显缩短，整个研究期间的中位数时间为 165min（95%置信区间 120-278）vs. 360min（95%置信区间 298-650；p<0.05）。在无结构性心脏病的患者、AF 持续时间短于 12 小时的患者和射血分数>55%的患者中，普罗帕酮在早期恢复窦性心律方面可能比奎尼丁更有效。
尽管两种药物的疗效相同，但接受普罗帕酮治疗的患者转复为窦性心律的速度更快，尽管阵发性 AF 发作时间较长。
