Aims This study compared the efficacy and safety of intravenous flecain ide and ibutilide for immediate cardioversion of atrial fibrillation (AF). Methods and results We conducted a prospective, randomised trial, incl...Aims This study compared the efficacy and safety of intravenous flecain ide and ibutilide for immediate cardioversion of atrial fibrillation (AF). Methods and results We conducted a prospective, randomised trial, including 207 patients wit h AF of recent onset (≤48 h). Flecainide was given over 20 min at a dose of 2 m g/kg body weight (maximum 200 mg), ibutilide was infused at a dose of 1 mg (or 0 .01 mg/kg if less than 60 kg) over 10 min, followed by a 10 min observation peri od and an identical second dose if AF did not convert to sinus rhythm (SR). Trea tment was considered successful if SR occurred within 90 min of starting medicat ion. The conversion rates were 56.4%in patients given flecainide and 50.0%in p atients given ibutilide (P=0.34). Multivariate analysis revealed that a lower ag e for women independently increased the probability of conversion. None of the o ther variables, including left atrial size, left ventricular systolic function, presence of left ventricular hypertrophy, plasma levels of potassium or magnesiu m at baseline, or concomitant use of digoxin, beta-blocker, diltiazem or verapa mil were predictors of conversion. The frequency of adverse events was comparabl e in the two treatment groups. Conclusions There was no significant difference i n the cardioversion efficacy or in the risk of adverse events between flecainide and ibutilide in patients with AF of recent onset. In patients without contrain dications to both medications, the physician’s choice has to be governed by oth er factors.展开更多
文摘Aims This study compared the efficacy and safety of intravenous flecain ide and ibutilide for immediate cardioversion of atrial fibrillation (AF). Methods and results We conducted a prospective, randomised trial, including 207 patients wit h AF of recent onset (≤48 h). Flecainide was given over 20 min at a dose of 2 m g/kg body weight (maximum 200 mg), ibutilide was infused at a dose of 1 mg (or 0 .01 mg/kg if less than 60 kg) over 10 min, followed by a 10 min observation peri od and an identical second dose if AF did not convert to sinus rhythm (SR). Trea tment was considered successful if SR occurred within 90 min of starting medicat ion. The conversion rates were 56.4%in patients given flecainide and 50.0%in p atients given ibutilide (P=0.34). Multivariate analysis revealed that a lower ag e for women independently increased the probability of conversion. None of the o ther variables, including left atrial size, left ventricular systolic function, presence of left ventricular hypertrophy, plasma levels of potassium or magnesiu m at baseline, or concomitant use of digoxin, beta-blocker, diltiazem or verapa mil were predictors of conversion. The frequency of adverse events was comparabl e in the two treatment groups. Conclusions There was no significant difference i n the cardioversion efficacy or in the risk of adverse events between flecainide and ibutilide in patients with AF of recent onset. In patients without contrain dications to both medications, the physician’s choice has to be governed by oth er factors.
