Despite a variety of available therapeutic strategies, maintenance of normal sinus rhythm after cardioversion from AF has remained an unresolved problem. The present study was undertaken to compare the efficacy and safety of disopyramide, propafenone and sotalol, which are traditionally categorized into different antiarrhythmic drug classes. Their almost similar efficacy in this study suggests that prevention of recurrence of AF may be equally well achieved by drugs with dissimilar predominant electrophysiological effects (eg, slowing of conduction with propafenone versus prolongation of refractoriness with sotalol).Our results are similar to those of other authors . Juul-Moller and associates compared the effectiveness of sotalol to that of quinidine in an open, parallel group study of 183 patients in whom therapy was started 2 h after successful electrical cardioversion. According to their primary efficacy assessment, 52% of sotalol-treated patients and 48% of patients receiving quinidine remained in sinus rhythm during a six-month follow-up period (not significant). Another important finding of this study was that more patients were withdrawn from quinidine than from sotalol treatment due to side effects (26% versus 11%, P<0.05).
Reimold et al compared propafenone with sotalol in 100 patients who had paroxysmal AF or after cardioversion of chronic AF and previous unsuccessful therapy with class Ia drugs. The underlying etiology of AF was valvular heart disease (30%), hypertension (19%), idiopathic AF (16%), coronary artery disease (16%) and other diagnoses (31%). At follow-up of three, six and 12 months, in the sotalol-treated group 49%, 46% and 37%, respectively, and in the propafenone-treated group 46%, 41% and 30%, respectively, of patients remained in sinus rhythm.
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