Effect of Verapamil on Immediate Recurrence of Atrial Fibrillation

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Abstract
Immediate Recurrence of AF. Introduction: The purpose of this study was to assess the effect of verapamil on immediate recurrences of atrial fibrillation occurring after successful electrical cardioversion.Methods and Results: The effect of verapamil on the recurrence of atrial fibrillation within 5 minutes after successful transthoracic cardioversion was assessed in 19 (5%) of 364 patients undergoing electrical cardioversion. The mean duration of atrial fibrillation was 4.44 ± 3.0 months. In the 19 patients, cardioversion was successful after each of three consecutive cardioversion attempts per patient; however, atrial fibrillation recurred 0.4 ± 0.3 minutes after cardioversion. Verapamil 10 mg was administered intravenously and fourth cardioversion was performed. Cardioversion after verapamil was successful in each patient, and atrial fibrillation did not recur in 9 (47%) of 19 patients (P < 0.001 vs before verapamil). In the remaining 10 patients in whom atrial fibrillation recurred, the duration of sinus rhythm was significantly longer compared with before verapamil (3,6 ± 2.4 min, P < 0.001). The density of atrial ectopy occurring after cardioversion was significantly less after verapamil (21 ± 14 ectopic beats per min) compared with before verapamil (123 ± 52 ectopic beats per min, P < 0.001).Conclusion: Among patients with immediate recurrence of atrial fibrillation after electrical cardioversion, acute calcium channel blockade by verapamil reduces recurrence of atrial fibrillation and extends the duration of sinus rhythm.

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