Karlsson and coworkers randomized 44 patients to di-sopyramide and 46 to placebo in a double-blind multicentre study. The most common diagnosis in both groups was lone AF. After one year, 30% of patients in the placebo group and 54% in the disopyramide group were still in sinus rhythm (P<0.01). Five patients in the disopyramide group (11%) and two in the placebo group were withdrawn because of side effects.
Although in the present study several side effects were associated with each agent, only four patients discontinued therapy due to adverse effects. We did not observe life-threatening ventricular proarrhythmia, which was probably connected with restricted, broad exclusion criteria, small dose of antiarrhythmic drugs and a small number of patients. As we expected, the lowest heart rate was observed in sotalol-treated patients on 24 h Holter ECG monitoring.
The choice of prophylactic antiarrhythmic drug must take into consideration effectiveness and safety of therapy. The sequential use of different types of antiarrhythmic drugs may improve arrhythmia prognosis in chronic AF after successful electrical cardioversion . The rationale for serial treatment is that the arrhythmogenic mechanism may vary among patients, leading to different responses to a specific drug.
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