[Intravenous propafenone for conversion of atrial fibrillation in the emergency room]

Atrial fibrillation (AF) is the most common sustained symptomatic arrhythmia encountered in the emergency room (ER). Rapid, safe and effective conversions of AF to sinus rhythm (SR) are important aspects in the treatment of arrhythmia in a busy ER setting. The aim of our study was to investigate the rate of conversion, efficacy and safety of intravenous (i.v.) propafenone administration for the treatment of AF in the ER. Seventy five patients (pts), admitted in the ER with symptomatic AF were randomized to receive propafenone or placebo: 40 pts received propafenone as an i.v. bolus of 2 mg/kg in 15 minutes, followed by maintenance infusion of 0.0067 mg/kg/min until conversion to SR or for up to 90 minutes (Group 1). The matching placebo (an equal volume of saline solution) was administered to 35 pts in the same fashion (Group 2). Direct current (DC) cardioversion was attempted in pts still in AF 15 minutes after infusion administration was terminated. SR was achieved in 24 pts treated with propafenone (60%) versus 10 pts treated with placebo (29%) (p<0.02) and the median conversion time was 15 minutes versus 105 minutes respectively (p<0.001). None of the pts who were in AF for more than 48 hours were converted to SR by infusion. Five patients had mild and transient adverse event during propafenone treatment versus none with placebo (p=ns). Therefore, we conclude that i.v. administration of propafenone in the ER is an effective, rapid and safe therapeutic alternative for pts with symptomatic AF.