Randomized comparison of flecainide and cibenzoline in the conversion of atrial fibrillation

The efficacy of oral cibenzoline (260 mg/day and 320 mg/day) and flecainide (200 mg/day and 300 mg/day) in the conversion of chronic atrial fibrillation to sinus rhythm were compared in 31 patients in a randomized order. If sinus rhythm was not restored on the 5th day of oral treatment with either cibenzoline or flecainide (phase of initial treatment) patients were switched to a second phase of treatment with the drug not given in the first phase after a washout phase of 3 days. Sinus rhythm was restored in 7/28 treatment trials with cibenzoline and in 7/23 treatment trials with flecainide (not significant). Trough levels of cibenzoline and flecainide in the plasma were not significantly different between patients in whom sinus rhythm was restored and patients with persisting atrial fibrillation. In patients successfully converted to sinus rhythm, long-term treatment was instituted with flecainide (n = 6) or cibenzoline (n = 6). Atrial fibrillation developed in 2 patients in each group of patients within 3 months. In all other patients, sinus rhythm was maintained during the follow-up period of 12 months. Non-cardiac side effects were observed in 2 patients during treatment with cibenzoline and flecainide respectively. With flecainide, one patient developed sinus arrest up to 5.6 seconds.