The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery.

OBJECTIVE

The primary objective was to evaluate the efficacy of propafenone compared with amiodarone in the reversion of atrial fibrillation or flutter. The secondary objective was the assessment of the tolerance of propafenone versus amiodarone.

DESIGN

An open, randomized trial.

SETTING

A single university hospital.

PARTICIPANTS

Forty patients who gave their informed consent.

INTERVENTIONS

These patients underwent cardiac bypass surgery or aortic valvular replacement. For treatment of postsurgical arrhythmias, they either received intravenous propafenone, 1 to 2 mg/kg in a 10-minute bolus, followed by an infusion of 420 mg in 24 hours, or amiodarone, 2.5 to 5 mg/kg, in a 10-minute bolus followed by an infusion of 900 mg in 24 hours.

MEASUREMENTS AND MAIN RESULTS

Sinus rhythm was restored in 12 of 18 (67%) propafenone patients and in 17 of 22 (77%) amiodarone patients. If the early success time-limit had been fixed at 60 minutes, the proportion would have been 41% (7/17) for propafenone versus 14% (3/22) for amiodarone, and that difference is nearly significant (p = 0.07 Fisher's exact test). However, after 210 minutes, 50% of the propafenone patients regained sinus rhythm versus only 25% of the amiodarone patients. Hemodynamic parameters improved with time in both groups without showing any statistically significant difference.

CONCLUSIONS

The results suggest that propafenone produces a more prompt effect in converting patients from atrial fibrillation or flutter to normal sinus rhythm.