Propafenone for maintaining sinus rhythm after cardioversion of atrial fibrillation

Propafenone is more effective than placebo in reducing atrial fibrillation recurrence after cardioversion.

Summary

A Cochrane review on antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation included 59 studies with a total of 21 305 subjects. Propafenone was included in 12 of the studies with a total of 2 158 subjects, and 5 of them compared propafenone with placebo. Outcomes were pooled at one year of follow-up.

Compared to placebo propafenone reduced atrial fibrillation recurrence (Peto OR 0.37, 95% CI 0.28 to 0.48; 5 studies, n=1 098). There was no significant difference in mortality between propafenone and placebo (Peto OR 0.05, 95% CI 0.00 to 1.02; 5 studies, n=1 098). Propafenone increased withdrawals due to adverse effects (Peto OR 1.69, 95% CI 1.09 to 2.62; 5 studies, n=1 098) compared with placebo.

Pooled recurrence rates of atrial fibrillation at 1 year were high: 69% to 84% in controls not receiving antiarrhythmic treatment, reduced to 43% to 67% in patients treated with antiarrhythmics. The corresponding average NNTBs for 1 year, to avoid 1 recurrence of atrial fibrillation, were 3 with amiodarone, 4 with flecainide, 5 with dofetilide and propafenone, 8 with quinidine and sotalol, 9 with dronedarone and metoprolol, and 17 with azimilide (the 95% CI varied between 2 and 60).

Clinical comments

Date of latest search:

Ədəbiyyat

1. Lafuente-Lafuente C, Valembois L, Bergmann JF et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2015;(3):CD005049.