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 .
Suppression of paroxysmal atrial tachyarrhythmias--results of the SOPAT trial.
AIM The indication to treat paroxysmal atrial fibrillation ( PAF ) is controversial . The Suppression of Paroxysmal Atrial Tachyarrhythmias ( SOPAT ) trial was design ed to answer the following questions : ( 1 ) What is the average rate of spontaneous events of symptomatic PAF with and without anti-arrhythmic medication ? ( 2 ) what is the prevalence of severe side-effects ? and ( 3 ) is the fixed combination of Quinidine + Verapamil inferior to the efficacy of sotalol or not ? METHODS AND RESULTS Within 60 months 172 centres in Germany , Pol and , and The Slovak Republic prospect ively enrolled 1033 patients ( mean age 60 years , 62 % male ) with documented frequent episodes of symptomatic PAF . Patients were r and omised to either Quinidine + Verapamil 480/240 mg/d ( high dose ; 263 patients ) , Quinidine + Verapamil 320/160 mg/d ( low dose ; 255 patients ) , Sotalol 320 mg/d ( 264 patients ) or placebo ( 251 patients ) , of which 1012 patients entered the intention-to-treat analysis . The primary endpoint was the time to first recurrence of symptomatic PAF or premature discontinuation . Secondary outcome parameters were the total number of symptomatic episodes and tolerability of the tested drugs . Patients were followed for a period of up to 12 months by daily and symptom-triggered trans-telephonic ECG-monitoring ( Tele-ECG ) . The mean time under treatment was 233 + /- 152 days . Regarding the primary endpoint , all active treatments were superior to placebo and not different from each other . A total of 756 patients reached the primary endpoint within 105.7 + /- 8.7 d ( mean + /- SEM ) in the placebo group , vs. Quinidine + Verapamil ( high dose ) ( 150.4 + /- 10 d , p = 0.0061 ) , vs. Quinidine + Verapamil ( low dose ) ( 148.9 + /- 10.6 d , p = 0.0006 ) , vs. Sotalol ( 145.6 + /- 93 d , p = 0.0007 ) . All three treatments were also effective in the reduction of AF burden ( days with symptomatic AF [ % ] mean + /- SD , p vs. placebo ) : Quinidine + Verapamil ( high dose ) ( 3.4 + /- 12 , p = 0.0001 ) , Quinidine + Verapamil ( low dose ) ( 4.5 + /- 12.3 , p = 0.008 ) and Sotalol ( 2.9 + /- 6.5 , p = 0.026 ) compared to placebo ( 6.1 + /- 13.5 ) . A total of four deaths , 13 syncopes , and one ventricular tachycardia ( VT ) occurred during the active study period , of which one death and one VT were related to Quinidine/Verapamil . CONCLUSION Taken together , anti-arrhythmic therapy with the fixed combination of Quinidine + Verapamil is as effective as Sotalol in the reduction of the recurrence rate of symptomatic PAF  with a low but definite risk of severe side-effects
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 .