Cardioversion of Recent Onset Atrial Fibrillation: Which Drug to Prefer in the Individual Patient?

  • P. E. Vardas
  • E. M. Kanoupakis
Conference paper


The management of atrial fibrillation (AF) still represents one of the therapeutic challenges of modern cardiology. This arrhythmia is extremely common, particularly in elderly persons and in patients with organic heart disease, and carries the risk of embolic complications, especially cerebrovascular accidents [1,2].


Atrial Fibrillation Sinus Rhythm Atrial Flutter Electrical Cardioversion Intravenous Amiodarone 
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  1. 1.
    Kannel WB, Abbot RD, Savage DD et al (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306:1018–1022PubMedCrossRefGoogle Scholar
  2. 2.
    Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke. The Framingham Study. Stroke 22:983–988CrossRefGoogle Scholar
  3. 3.
    Wyse DG, Waldo AL, DiMarco JP et al, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825–1833PubMedCrossRefGoogle Scholar
  4. 4.
    Van Gelder IC, Hagens VE, Bosker HA et al, Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840PubMedCrossRefGoogle Scholar
  5. 5.
    Allessie M, Rensma PPL, Lammers WJEP et al (1989) The role of refractoriness, conduction velocity and wavelength in initiation of atrial fibrillation in normal dogs. In: Attuel P, Coumel P, Janse MJ (eds) The atrium in health and disease. Futura, Mount Kisco, NY, p 27–41Google Scholar
  6. 6.
    Wijfells MC, Kirchhof CJHJ, Dorland R et al (1995) Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92:1954–1968CrossRefGoogle Scholar
  7. 7.
    Farshi R, Kistner D, Sarma JSM, Longmate JA, Singh BN (1999) Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 33: 304–310PubMedCrossRefGoogle Scholar
  8. 8.
    Klein HO, Kaplinsky E (1986) Digitalis and verapamil in atrial fibrillation and flutter: is verapamil now the preferred agent? Drugs 31:85–197CrossRefGoogle Scholar
  9. 9.
    David D, Segni ED, Klein H ( 1979) Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta-adrenergic blocking agent. Am J Cardiol 4:1378–1382CrossRefGoogle Scholar
  10. 10.
    Dell-Orfano JT, Patel H, Wolbrette DL, Luck JC, Naccarelli GV (1999) Acute treatment of atrial fibrillation: spontaneous conversion rates and cost of care. Am J Cardiol 83:788–790CrossRefGoogle Scholar
  11. 11.
    Danias PG, Caulfield TA, Weigner MJ, Silverman DI, Manning WJ (1998) Likelihood of spontaneous conversion of atrial fibrillation to sinus rhythm. J Am Coll Cardiol 313:588–592CrossRefGoogle Scholar
  12. 12.
    Naccarelli GV, Dell’Orfano JT, Wolbrette DL, Patel H, Luck JC (2000) Acute cost-effective management of atrial fibrillation: role of rate control, spontaneous conversion, cardioversion, and antiembolic therapy. Am J Cardiol 85:36D–45DPubMedCrossRefGoogle Scholar
  13. 13.
    Fuster V, Rydén LE, Asinger RW et al (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 38:1231–1265PubMedCrossRefGoogle Scholar
  14. 14.
    Kochiadakis GE, Igoumenidis NE, Solomou MC et al (1998) Conversion of atrial fibrillation to sinus rhythm using acute intravenous procainamide infusion. Cardiovasc Drugs Ther 12:75–81PubMedCrossRefGoogle Scholar
  15. 15.
    Capucci A, Tiziano L, Boriani G et al (1992) Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension. Am J Cardiol 70:69–72PubMedCrossRefGoogle Scholar
  16. 16.
    Crijns HJGM, van Vijk M, van Gilst WH et al (1988) Acute conversion of atrial fibrillation to sinus rhythm: clinical efficacy of flecainide acetate. Comparison of two regimens. Eur Heart J 9:634–639PubMedGoogle Scholar
  17. 17.
    Capucci A, Boriani G, Rubino I et al (1994) A controlled study on oral propafenone versus digoxin plus quinidine in converting recent onset atrial fibrillation to sinus rhythm. Int J Cardiol 43:305–311PubMedCrossRefGoogle Scholar
  18. 18.
    Boriani G, Biffi M, Capucci A et al (1997) Oral propafenone to convert recent-onset atrial fibrillation in patients with and without underlying heart disease. A randomized controlled trial. Ann Intern Med 126:621–624PubMedGoogle Scholar
  19. 19.
    Suttorp MJ, Kingma HJ, Jessurun ER et al (1990) The value of class 1C antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. J Am Coll Cardiol 16:1722–1727PubMedCrossRefGoogle Scholar
  20. 20.
    Galve E, Rius T, Ballester R et al (1996) Intravenous amiodarone in the treatment of recent-onset atrial fibrillation. Results of a randomized, controlled trial. J Am Coll Cardiol 27:1079–1082PubMedCrossRefGoogle Scholar
  21. 21.
    Vardas PE, Kochiadakis GE, Igoumenidis NE et al (2000) Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation: a randomized, controlled study. Chest 117:1538–1545PubMedCrossRefGoogle Scholar
  22. 22.
    Pritchett ELC (1992) Management of atrial fibrillation. N Engl J Med 326:1264–1271PubMedCrossRefGoogle Scholar
  23. 23.
    Management of patients with atrial fibrillation (1996) A statement for healthcare professionals from the subcommittee on electrocardiography and electrophysiology, American Heart Association. Circulation 93:1262–1277CrossRefGoogle Scholar
  24. 24.
    Nattel S (1995) Newer developments in the management of atrial fibrillation. Am Heart J 130:1094–1106PubMedCrossRefGoogle Scholar
  25. 25.
    Falk RH (1994) Current management of atrial fibrillation. Curr Opin Cardiol 9:30–39PubMedCrossRefGoogle Scholar
  26. 26.
    Hou ZY, Chang MS, Chen CY et al (1995) Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. Eur Heart J 16:521–528PubMedGoogle Scholar
  27. 27.
    Levy S (1994) Amiodarone as a first-line drug in the treatment of atrial fibrillation: The Protagonist Viewpoint. Cardiovasc Drugs Ther 8:769–771PubMedCrossRefGoogle Scholar
  28. 28.
    Kochiadakis GE, Igoumenidis NE, Simantirakis EN et al (1998) Intravenous propafenone versus intravenous amiodarone in the management of atrial fibrillation of recent onset: a placebo-controlled study. Pacing Clin Electrophysiol 21:2475–2479PubMedCrossRefGoogle Scholar
  29. 29.
    Chevalier P, Durand-Dubief A, Burri H et al (2003) Amiodarone versus placebo and classic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis. J Am Coll Cardiol 41:255–262PubMedCrossRefGoogle Scholar
  30. 30.
    Blanc JJ, Voinov C, Marek M (1999) Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group. Am J Cardiol 84:1029–1032PubMedCrossRefGoogle Scholar
  31. 31.
    Kowey PR, Marinchak RA, Rials SJ, Filart RA (1997) Intravenous amiodarone. J Am Coll Cardiol 29:1190–1198PubMedCrossRefGoogle Scholar
  32. 32.
    Schwartz A, Shen E, Morady F et al (1983) Hemodynamic effects of intravenous amiodarone in patients with depressed left ventricular function and recurrent ventricular tachycardia. Am Heart J 106:848–856PubMedCrossRefGoogle Scholar
  33. 33.
    Gottlieb SS, Riggio DW, Lauria S et al (1994) High dose oral amiodarone loading exerts important hemodynamic actions in patients with congestive heart failure. J Am Coll Cardiol 23:560–564PubMedCrossRefGoogle Scholar
  34. 34.
    Jafari-Fesharaki M, Scheinman MM (1998) Adverse effects of amiodarone. Pacing Clin Electrophysiol 21:108–120PubMedCrossRefGoogle Scholar
  35. 35.
    Wellens J, Brugada P, Abdollah H, Dassen WR ( 1984) A comparison of the electrophy-siologic effects of intravenous and oral amiodarone in the same patient. Circulation 69:120–124PubMedCrossRefGoogle Scholar
  36. 36.
    Kanoupakis EM, Kochiadakis GE, Manios EG et al (2003) Pharmacological cardioversion of recent onset atrial fibrillation with intravenous amiodarone in patients receiving long-term amiodarone therapy: is it reasonable? J Interv Card Electrophysiol 8:19–26PubMedCrossRefGoogle Scholar
  37. 37.
    Stambler BS, Wood MA, Ellenbogen KA et al (1996) Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Ibutilide Repeat Dose Study Investigators. Circulation 94:1613–1621PubMedCrossRefGoogle Scholar
  38. 38.
    Falk RH, Pollak A, Singh SN, Friedrich T (1997) Intravenous dofetilide, a class III antiarrhythmic agent, for the termination of sustained atrial fibrillation or flutter. Intravenous Dofetilide Investigators. J Am Coll Cardiol 29:385–390PubMedCrossRefGoogle Scholar
  39. 39.
    Bianconi L, Castro A, Dinelli M et al (2000) Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter: a multicentre, randomized, double-blind, placebo-controlled study. Eur Heart J 21(15):1265–1273PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • P. E. Vardas
    • 1
  • E. M. Kanoupakis
    • 1
  1. 1.Department of CardiologyHeraklion University HospitalHeraklion, CreteGreece

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