Acute Conversion of Recent-Onset Atrial Fibrillation and Flutter: Class IC or Class III Drugs?

  • R. F. Guaragna
  • C. H. Chen
  • D. Bracchetti
Conference paper


How long atrial fibrillation should go on, in order to be considered of recent onset (less than 24 h? 7 days? more?), is a moot point that raises confusion when it comes to evaluating the efficacy of an antiarrhythmic regimen. In any case, the longer the arrhythmia continues, the less likely is its conversion into sinus rhythm, because of the electric remodeling of the atria (shortening of the refractory period) caused by the persistent fibrillation. Similarly, the risk of thromboembolic complications increases with the duration of the arrhythmia, so that any attempt at cardioversion beyond 48 h must be carried out after full anticoagulation therapy [1]. If recent-onset atrial fibrillation or flutter bring about hemodynamic instability, electrical cardioversion is recommended (success rate 75%–95%), otherwise sinus rhythm can be restored using antiarrhythmic drugs.


Atrial Fibrillation Sinus Rhythm Antiarrhythmic Drug Atrial Flutter Antiarrhythmic Agent 


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  1. 1.
    Levy S, Breithardt G, Campbell RWF et al, on behalf of the working Group on Arrhythmias of the European Society of Cardiology (1998) Atrial fibrillation: current knowledge and recommendations for management. Eur Heart J 19:1294–1320PubMedCrossRefGoogle Scholar
  2. 2.
    Lindsay BD, Smith JM (1996) Electrophysiologic aspects of human fibrillation. Cardiol Clinics 14:483–505CrossRefGoogle Scholar
  3. 3.
    Janse MJ (1992) To prolong refractoriness or to delay conduction (or both)? Eur Heart J 13:14–18PubMedCrossRefGoogle Scholar
  4. 4.
    Task force of the working group on arrhythmias of the European Society of Cardiology (1991) The Sicilian gambit. A new approach to the classification of antiarrhythmic drugs based on their actions on antiarrythmic mechanisms. Circulation 84:1831–1851CrossRefGoogle Scholar
  5. 5.
    Singh BN (1997) Acute conversion of atrial fibrillation and flutter: direct current cardioversion versus intravenously administered pure class III Agents. J Am Clin Cardiol 29:391–393CrossRefGoogle Scholar
  6. 6.
    Singh BN, Nademanee K (1985) Control of cardiac arrhythmias by selective lengthening of repolarization: theoretic considerations and clinical observations.Am Heart J 109:421–430PubMedCrossRefGoogle Scholar
  7. 7.
    Suttorp MJ, Kingma JH, Jessurun ER et al (1990) The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. J Am Clin Cardiol 16:1722–1727CrossRefGoogle Scholar
  8. 8.
    Bianconi L, Boccadamo R, Pappalardo A et al (1989) Effectiveness of intravenous propafenone for cardioversion of atrial fibrillation of recent onset. Am J Cardiol 64:335–338PubMedCrossRefGoogle Scholar
  9. 9.
    Bellandi F, Cantini F, Pedone T et al (1995) Effectiveness of intravenous propafenone for conversion of recent onset atrial fibrillation: a placebo-controlled study. Clin Cardiol 18:631–634PubMedCrossRefGoogle Scholar
  10. 10.
    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 43:305–313PubMedCrossRefGoogle Scholar
  11. 11.
    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 randomised controlled trial. Ann Intern Med 126:621–625Google Scholar
  12. 12.
    Capucci A, Boriani G, Botto GL et al (1994) Conversion of recent onset atrial fibrillation by a single oral loading dose of propafenone and flecainide. Am J Cardiol 74:503–505PubMedCrossRefGoogle Scholar
  13. 13.
    Crijns HJGM, Van Wijk LM, Van Gilst WM et al (1988) Acute conversion of atrial fibrillation to sinus rhythm: clinical efficacy of flecainide acetate. Comparaison of two regimens. Eur Heart J 9:634–638PubMedGoogle Scholar
  14. 14.
    Donovan KD, Power BM, Hockings BEF et al (1995) Intravenous flecainide versus amiodarone for recent onset atrial fibrillation. Am J Cardiol 75:693–697PubMedCrossRefGoogle Scholar
  15. 15.
    Madrid AH, Moro C, Marin-Huerta E et al (1993) Comparaison of flecainide and procainamide on cardioversion of atrial fibrillation. Eur Heart J 14:1127–1131PubMedCrossRefGoogle Scholar
  16. 16.
    Capucci A, Lenzi T, 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
  17. 17.
    Kingma JH, Suttorp MJ (1992) Acute pharmacologic conversion of atrial fibrillation and flutter: the role of flecainide, propafenone and verapamil. Am J Cardiol 70:56A–61APubMedCrossRefGoogle Scholar
  18. 18.
    Faniel R, Schoenfeld PH (1983) Efficacy of i.v. amiodarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients. Eur Heart J 4:180–185PubMedGoogle Scholar
  19. 19.
    Strasberg B, Arditti A, Sclarowsky S et al (1985) Efficacy of intravenous amiodarone in the management of paroxysmal or new atrial fibrillation with fast ventricular response. Int J Cardiol 7:47–55PubMedCrossRefGoogle Scholar
  20. 20.
    Galve E, Rius T, Ballester R et al (1996) Intravenous amiodarone in treatment of recent onset atrial fibrillation: results of a randomised controlled study. J Am Coll Cardiol 27:1079–1082PubMedCrossRefGoogle Scholar
  21. 21.
    Falk RH, Pollak A, Singh SN et al for the intravenous dofetilide investigators (1997) Intravenous dofetilide, a class III antiarrhythmic agent, for the termination of sustained atrial fibrillation or flutter. J Am Coll Cardiol 29:385–390PubMedCrossRefGoogle Scholar
  22. 22.
    Sedgwick ML, Lip G, Rae AP et al (1995) Chemical cardioversion of atrial fibrillation with intravenous dofetilide. Intern J Cardiol 49:159–166CrossRefGoogle Scholar
  23. 23.
    Suttorp JM, Polak PE, Vant Hof A et al (1992) Efficacy and safety of a new selective class III antiarrhythmic agent dofetilide in paroxysmal atrial fibrillation and atrial flutter. Am J Cardiol 69:417–419PubMedCrossRefGoogle Scholar
  24. 24.
    Crijns HJGM, Van Gelder C, Kingma JH et al (1994) Atrial flutter can be terminated by a class III antiarrhythmic drug but not by a class I C drug. Eur Heart J 15:1403–1408PubMedCrossRefGoogle Scholar
  25. 25.
    Ellenbogen KA, Stambler BS, Wood MA et al, for the ibutilide investigators (1996) Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and atrial flutter: a dose-response study. J Am Coll Cardiol 28:130–136PubMedCrossRefGoogle Scholar
  26. 26.
    Stambler BS, Wood MA, Ellenbogen KA et al, for the ibutilide repeat dose study investigators (1996) Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Circulation 94:1613–1621PubMedCrossRefGoogle Scholar
  27. 27.
    Stambler BS, Wood MA, Ellenbogen KA et al (1996) Comparative efficacy of intravenous ibutilide versus procainamide for enhancing termination of atrial flutter by atrial overdrive pacing. Am J Cardiol 77:960–966PubMedCrossRefGoogle Scholar
  28. 28.
    Murray KT (1998) Ibutilide. Circulation 97:493–497PubMedCrossRefGoogle Scholar
  29. 29.
    Kowey PR, Vanderlungt JT, Luderer JR (1996) Safety and risk/benefit analysis of ibutilide to acute conversion of atrial fibrillation. Am J Cardiol 78:46–52PubMedCrossRefGoogle Scholar
  30. 30.
    Sung RJ, Tan HL, Karagounis L et al, for the Sotalol Multicenter Study Group (1995) Intravenous Sotalol for the termination of supraventricular tachycardia and atrial fibrillation/flutter: a multicenter randomised double blind placebo controlled study. Am Heart J 129:739–748PubMedCrossRefGoogle Scholar
  31. 31.
    Reisenger J, Gatterer E, Kuen P et al (1977) Flecainide versus Sotalol for immediate conversion of atrial fibrillation. J Am Coll Cardiol 29:471 AGoogle Scholar
  32. 32.
    Vos MA, Golitsyn SR, Stangle K et al, for the Ibutilide/Sotalol Comparator Study Group (1998) Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. Heart 79:568–575PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • R. F. Guaragna
    • 1
  • C. H. Chen
    • 1
  • D. Bracchetti
    • 1
  1. 1.Unità Operativa di CardiologiaOspedale MaggioreBolognaItaly

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