The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery

Objective: The primary objective was to evaluate the efficacy of propafenone compared with amiodarone in the reversion of atrial fibrillation or flutter. The secondary objective was the assessment pf the tolerance of propafenone versus amiodarone. Design: An open, randomized trial. Setting: A single university hospital. Participants: Forty patients who gave their informed consent. Interventions: These patients underwent cardiac bypass surgery or aortic valvular replacement. For treatment of postsurgical arrhythmias, they either received intravenous propafenone, 1 to 2 mg/kg in a 10-minute bolus, followed by an infusion of 420 mg in 24 hours, or amiodarone, 2.5 to 5 mg/kg, in a 10-minute bolus followed by an infusion of 900 mg in 24 hours. Measurements and Main Results: Sinus rhythm was restored in 12 of 18 (67%) propafenone patients and in 17 of 22 (77%) amiodarone patients. If the early success time-limit had been fixed at 60 minutes. the proportion would have been 41% (7/17) for propafenone versus 14% (3/22) for amiodarone. and that difference is nearly significant (p = 0.07 Fisher's exact test). However. after 210 minutes, 50% of the propafenone patients regained sinus rhythm versus only 25% of the amiodarone patients. Hemodynamic parameters improved with time in both groups without showing any statistically significant difference. Conclusions: The results suggest that propafenone produces a more prompt effect in converting patients from atrial fibrillation or nutter to normal sinus rhythm. (C) 1996 by W.B. Saunders Company