Circulation, Vol 82, 1106-1116, Copyright © 1990 by American Heart Association
SE Coplen, EM Antman, JA Berlin, P Hewitt and TC Chalmers
Because individual studies evaluating the role of quinidine in the
maintenance of sinus rhythm after cardioversion from chronic atrial
fibrillation have involved relatively few patients, a meta-analysis of
randomized control trials was performed. Six trials published between 1970
and 1984 were selected by two blinded reviewers based on study design and
statistical analysis. Data from these six trials involving 808 patients
were pooled after testing for homogeneity of treatment effects across
trials. Life table estimates of the percent of patients still in sinus
rhythm at 3, 6, and 12 months after cardioversion were constructed for
quinidine and control groups. The proportion of patients remaining in sinus
rhythm in the quinidine group was 69%, 58%, and 50% at 3, 6, and 12 months
postcardioversion respectively. The proportion of patients remaining in
sinus rhythm in the control group was 45%, 33%, and 25% at the same time
intervals. The pooled rate difference, or difference in proportion of
patients in sinus rhythm between quinidine and control groups, was 24%,
23%, and 24% at 3, 6, and 12 months of follow-up (p less than 0.001 at all
time intervals). The unadjusted total mortality rate in the
quinidine-treated patients was 2.9% and in the control group was 0.8%. The
odds of dying in the quinidine-treated group were approximately three times
that of the control group ("typical" odds ratio = 2.98, p less than 0.05).
Thus, quinidine treatment is more effective than no antiarrhythmic therapy
in suppressing recurrences of atrial fibrillation but appears to be
associated with increased total mortality.
ARTICLES
Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials [published erratum appears in Circulation 1991 Feb;83(2):714]
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
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D. Roy, M. Talajic, P. Dorian, S. Connolly, M. J. Eisenberg, M. Green, T. Kus, J. Lambert, M. Dubuc, P. Gagne, et al. Amiodarone to Prevent Recurrence of Atrial Fibrillation N. Engl. J. Med., March 30, 2000; 342(13): 913 - 920. [Abstract] [Full Text] [PDF] |
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H Nakazawa, D.A Lythall, J Noh, N Ishikawa, K Sugino, K Ito, and S.M.C Hardman Is there a place for the late cardioversion of atrial fibrillation?. A long-term follow-up study of patients with post-thyrotoxic atrial fibrillation Eur. Heart J., February 2, 2000; 21(4): 327 - 333. [Abstract] [PDF] |
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A Capucci, G.Q Villani, D Aschieri, A Rosi, and M.F Piepoli Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation Eur. Heart J., January 1, 2000; 21(1): 66 - 73. [Abstract] [PDF] |
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S. H. Hohnloser, Y.-G. Li, B. Bender, and G. Gronefeld Review : Pharmacological Management of Atrial Fibrillation: An Update Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 2000; 5(1): 11 - 16. [Abstract] [PDF] |
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T. A. Burkart and A. B. Curtis Reviews: Atrial Fibrillation: Current and Future Strategies for Management Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 2000; 5(3): 151 - 160. [PDF] |
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S. J. Connolly Evidence-Based Analysis of Amiodarone Efficacy and Safety Circulation, November 9, 1999; 100(19): 2025 - 2034. [Full Text] [PDF] |
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N. Handa, H. V. Schaff, J. J. Morris, B. J. Anderson, S. L. Kopecky, and M. Enriquez-Sarano OUTCOME OF VALVE REPAIR AND THE COX MAZE PROCEDURE FOR MITRAL REGURGITATION AND ASSOCIATED ATRIAL FIBRILLATION J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 628 - 635. [Abstract] [Full Text] [PDF] |
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A E Tuinenburg, I C Van Gelder, M P V. Den Berg, J Brugemann, P J De Kam, and H J G M Crijns Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation Heart, October 1, 1999; 82(4): 486 - 493. [Abstract] [Full Text] [PDF] |
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C. Torp-Pedersen, M. Moller, P. E. Bloch-Thomsen, L. Kober, E. Sandoe, K. Egstrup, E. Agner, J. Carlsen, J. Videbak, B. Marchant, et al. Dofetilide in Patients with Congestive Heart Failure and Left Ventricular Dysfunction N. Engl. J. Med., September 16, 1999; 341(12): 857 - 865. [Abstract] [Full Text] [PDF] |
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W. G. Stevenson and L. W. Stevenson Atrial Fibrillation in Heart Failure N. Engl. J. Med., September 16, 1999; 341(12): 910 - 911. [Full Text] |
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K. Kamalvand, K. Tan, G. Lloyd, J. Gill, C. Bucknall, and N. Sulke Alterations in atrial electrophysiology associated with chronic atrial fibrillation in man Eur. Heart J., June 2, 1999; 20(12): 888 - 895. [Abstract] [PDF] |
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R. Lee, T. Nitta, R. B. Schuessler, D. C. Johnson, J. P. Boineau, and J. L. Cox The closed heart MAZE: a nonbypass surgical technique Ann. Thorac. Surg., June 1, 1999; 67(6): 1696 - 1702. [Abstract] [Full Text] [PDF] |
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E. Catherwood, W. D. Fitzpatrick, M. L. Greenberg, P. T. Holzberger, D. J. Malenka, B. R. Gerling, and J. D. Birkmeyer Cost-Effectiveness of Cardioversion and Antiarrhythmic Therapy in Nonvalvular Atrial Fibrillation Ann Intern Med, April 20, 1999; 130(8): 625 - 636. [Abstract] [Full Text] [PDF] |
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S. G. Pauker and M. H. Eckman Finding What You Seek: Analyzing Therapies for Nonvalvular Atrial Fibrillation Ann Intern Med, April 20, 1999; 130(8): 690 - 691. [Full Text] [PDF] |
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C.-P. Lau, H.-F. Tse, and G. M. Ayers Defibrillation-guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1217 - 1226. [Abstract] [Full Text] [PDF] |
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I.A Paraskevaidis, G.N Theodorakis, D.G Katritsis, D.P Tsiapras, E.G Livanis, and D.T Kremastinos Pulmonary vein flow analysis by transoesophageal echocardiography in patients with chronic atrial fibrillation; 1 year follow-up after cardioversion Eur. Heart J., March 1, 1999; 20(5): 375 - 385. [Abstract] [PDF] |
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G. B. J. Mancini and M. Schulzer Reporting Risks and Benefits of Therapy by Use of the Concepts of Unqualified Success and Unmitigated Failure : Applications to Highly Cited Trials in Cardiovascular Medicine Circulation, January 26, 1999; 99(3): 377 - 383. [Abstract] [Full Text] [PDF] |
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M. Valderrabano and B. N. Singh Review : Electrophysiologic and Antiarrhythmic Effects of Propafenone: Focus on Atrial Fibrillation Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1999; 4(3): 183 - 198. [PDF] |
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S. Riva, C. Tondo, C. Carbucicchio, P. Galimberti, G. Fassini, and P. Della Bella Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment Europace, January 1, 1999; 1(4): 242 - 247. [Abstract] [PDF] |
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C. Pandozi, L. Bianconi, M. Villani, G. Gentilucci, A. Castro, G. Altamura, A. P. Jesi, F. Lamberti, F. Ammirati, and M. Santini Electrophysiological Characteristics of the Human Atria After Cardioversion of Persistent Atrial Fibrillation Circulation, December 22, 1998; 98(25): 2860 - 2865. [Abstract] [Full Text] [PDF] |
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P. C. Deedwania, B. N. Singh, K. Ellenbogen, S. Fisher, R. Fletcher, and S. N. Singh Spontaneous Conversion and Maintenance of Sinus Rhythm by Amiodarone in Patients With Heart Failure and Atrial Fibrillation : Observations from the Veterans Affairs Congestive Heart Failure Survival Trial of Antiarrhythmic Therapy (CHF-STAT) Circulation, December 8, 1998; 98(23): 2574 - 2579. [Abstract] [Full Text] [PDF] |
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P. Delfaut, S. Saksena, A. Prakash, and R. B. Krol Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single- and dual-site right atrial pacing for arrhythmia prevention J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1900 - 1908. [Abstract] [Full Text] [PDF] |
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R. S. Stafford, D. C. Robson, B. Misra, J. Ruskin, and D. E. Singer Rate Control and Sinus Rhythm Maintenance in Atrial Fibrillation: National Trends in Medication Use, 1980-1996 Arch Intern Med, October 26, 1998; 158(19): 2144 - 2148. [Abstract] [Full Text] [PDF] |
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A. Liebold, A. Wahba, and D. E. Birnbaum Low-Energy Cardioversion With Epicardial Wire Electrodes: New Treatment of Atrial Fibrillation After Open Heart Surgery Circulation, September 1, 1998; 98(9): 883 - 886. [Abstract] [Full Text] [PDF] |
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M. H. Eckman, R. H. Falk, and S. G. Pauker Cost-effectiveness of Therapies for Patients With Nonvalvular Atrial Fibrillation Arch Intern Med, August 10, 1998; 158(15): 1669 - 1677. [Abstract] [Full Text] |
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