No other antiarrhythmic showed a significant effect on mortality compared with controls .
Class IA , IC , and III drugs are effective in maintaining sinus rhythm but increase adverse effects , and class IA drugs may increase mortality
BACKGROUND A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm .
We performed a systematic review to determine the effect of long-term treatment with those drugs on death , embolisms , adverse effects , and atrial fibrillation recurrence .
Pilsicainide for conversion and maintenance of sinus rhythm in chronic atrial fibrillation: a placebo-controlled, multicenter study.
BACKGROUND Pilsicainide is a newly synthesized antiarrhythmic agent with class Ic properties . Various antiarrhythmic agents have been used to convert atrial fibrillation ( AF ) to sinus rhythm or decrease the rate of relapse of AF . METHODS We r and omly assigned 62 patients with chronic AF to oral treatment of either a  placebo  ( 10 patients ) or  150 mg/day of pilsicainide ( 52 patients ) for 4 weeks before electrical cardioversion . Before oral administration of pilsicainide , 41 patients underwent transesophageal echocardiography  to investigate whether there was thrombus formation in the heart chambers . Patients without pharmacologic defibrillation underwent direct current cardioversion to restore sinus rhythm . After successful cardioversion , all patients continued to receive pilsicainide and were monitored for up to 2 years . RESULTS Before cardioversion , 11 patients in the pilsicainide group ( 21 % ) reverted to sinus rhythm . No patients in the placebo group reverted to sinus rhythm . Direct current cardioversion was performed in 51 patients ; however , 8 patients were not converted to sinus rhythm ( 5 patients receiving pilsicainide , 3 patients receiving placebo ) , and 3 patients needed intracardiac cardioversion to convert to sinus rhythm . Asymptomatic bradyarrhythmias were observed in 5 patients in the pilsicainide group . During the follow-up period , 33 patients ( 71 % ) in the pilsicainide group remained in sinus rhythm at 1 month ; this number decreased to 23 patients ( 49 % ) at 3 months , 20 ( 43 % ) at 6 months , 16 ( 34 % ) at 12 months , 16 ( 34 % ) at 18 months , and 16 ( 34 % ) at 24 months . All patients receiving placebo continued to receive placebo after the cardioversion , and AF recurred a few days after cardioversion in all cases . No independent discriminant variables were identified in the groups between maintenance and nonmaintenance of sinus rhythm . Although no serious side effects regarding pilsicainide have been documented , one patient died of acute myocardial infa rct ion , most likely not related to pilsicainide administration . CONCLUSIONS Pilsicainide is effective in restoring or maintaining sinus rhythm in patients with chronic AF lasting longer than an average duration of 22 months . No major adverse effects were observed
No other antiarrhythmic showed a significant effect on mortality compared with controls .
Class IA , IC , and III drugs are effective in maintaining sinus rhythm but increase adverse effects , and class IA drugs may increase mortality
BACKGROUND A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm .
We performed a systematic review to determine the effect of long-term treatment with those drugs on death , embolisms , adverse effects , and atrial fibrillation recurrence .