Intravenous amiodarone vs propafenone for atrial fibrillation and flutter after cardiac operation

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Abstract
The safety and efficacy of amiodarone and propafenone in convertingatrial fibrillation or flutter after cardiac surgery were compared in arandomized double-blind trial. Eighty-four patients with sustained atrialtachyarrhythmias of more than 30 min' duration, stable hemodynamic statusand neither preoperative atrial arrhythmias nor treatment with otherantiarrhythmis drugs, were randomized to receive amiodarone (46 patients: 5mg/kg over 15 min and then 15 mg/kg over the subsequent 24 h fornon-converting) or propafenone (38 patients: 2 mg/kg over 15 in and then 10mg/kg over the subsequent 24 h for non- converting). Nine of the 46patients (19.5%) receiving amiodarone converted to sinus rhythm within 1 hfollowing bolus injection compared with 17 of 38 patients (44.7%) treatedwith propafenone (P < 0.05). Within the 24 h study, 38 of 46 patients(82.6%) given amiodarone and 26 of 38 patients (68.4%) given propafenonewere converted to sinus rhythm (P = NS). A significantly progressivereduction in ventricular response, already evident at 10th min from thestart of treatment, was achieved in both groups of patients. Side effectsoccurred in six patients given propafenone (15.7%) and in five givenamiodarone (10.8%) (P = NS). The two drugs were equally effective inconverting postoperative atrial fibrillation and/or flutter after 24 halthough propafenone was superior within the first hour.

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