Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .
Comparison between propafenone and digoxin administered intravenously to patients with acute atrial fibrillation. PAFIT-3 Investigators. The Propafenone in Atrial Fibrillation Italian Trial.
In recent-onset atrial fibrillation , intravenous propafenone has been shown to effectively restore sinus rhythm , whereas the efficacy of intravenous digoxin has been question ed . We directly compared these 2 drugs and placebo in acute atrial fibrillation . One hundred twenty-three patients with atrial fibrillation lasting < 72 hours were r and omized to a 10-minute intravenous infusion of either propafenone ( 2 mg/kg , 41 patients ) or digoxin ( 0.007 mg/kg , 40 patients ) or placebo ( 42 patients ) . After 1 hour , nonconverted propafenone or digoxin patients were switched to the alternative drug , while nonconverted placebo patients were r and omized to either propafenone or digoxin . The observation time ended 1 hour later . By 1 hour , conversion rates were 49 % in the propafenone group , 32 % in the digoxin group ( p = 0.12 ) , and 14 % in placebo group ( p < 0.001 vs propafenone , p = 0.08 vs digoxin ) . After crossover , digoxin converted 5 % of propafenone patients , while propafenone converted 48 % of digoxin patients ( p < 0.05 ) . In the 36 nonconverted  placebo patients , sinus rhythm was obtained in 53 % of cases with propafenone , and in 5 % with digoxin ( p < 0.05 ) . Globally , among the 116 patients who received a drug as first treatment , 30 of 60 patients ( 50 % ) were converted by propafenone versus 14 of 56 ( 25 % ) by digoxin ( p < 0.01 ) ( odds ratio 2.0 , 95 % confidence interval 1.19 to 3.36 ) . In nonconverters , the ventricular rate reduction was faster ( 15 vs 45 minutes ) and more prominent ( -24 % vs -14 % ) with propafenone than with digoxin . In conclusion , intravenous propafenone  terminates atrial fibrillation more effectively than either placebo or intravenous digoxin . In addition , in nonconverted patients , it obtains a more rapid and marked control of the ventricular rate
Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .