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 .
Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial.
AIMS In patients with persistent atrial fibrillation ( AF ) , the efficacy and safety of two anti-arrhythmic drugs in preventing the recurrence of AF after successful direct current ( DC ) cardioversion was prospect ively assessed in a multi-centre double-blind , placebo-controlled , r and omised trial using daily trans-telephonic monitoring . METHODS AND RESULTS 1182 patients with persistent AF were prospect ively enrolled , 848 patients were successfully cardioverted and then r and omised to either sotalol ( 383 patients ) , quinidine plus verapamil ( 377 patients ) or placebo ( 88 patients ) . The primary outcome parameter was AF recurrence or death . All patients received an event recorder ( Tele-ECG ) and had to record and transmit via telephone at least one ECG per day during follow-up . The mean follow-up period was 266 days . A total of 191,103 Tele-ECGs were recorded and transmitted . The primary outcome parameter ( AF recurrence of any kind or death ) was observed in 572 patients ( 67 % ) in whom at least one episode of AF recurrence was documented during follow-up , in 348 patients ( 41 % ) AF recurrence was persistent . The recurrence rates after one year for any AF were 83 % for placebo , 67 % for sotalol and 65 % for quinidine plus verapamil , the latter being statistically superior to placebo but not different from sotalol . The recurrence rates for the secondary outcome parameter persistent AF were 77 % , 49 % and 38 % , respectively . Quinidine plus verapamil was significantly superior to placebo and to sotalol . About 95 % of all AF recurrences were initially detected in the daily Tele-ECG , about 70 % of all AF recurrences occurred completely asymptomatic . Adverse events on sotalol and quinidine plus verapamil were comparable with the exception that all torsade de pointes tachycardias occurred on sotalol . CONCLUSION Anti-arrhythmic treatment after DC cardioversion of persistent AF significantly decreases the recurrence rates of persistent AF compared to placebo with superiority of quinidine plus verapamil compared to sotalol . Symptoms were not reliable as clinical surrogates to detect episodes of AF
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 .