Which antiarrhythmic drug to choose after electrical cardioversion: A study on non-valvular atrial fibrillation...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Electrical cardioversion is a common treatment for atrial fibrillation (AF).
• The comparative effectiveness of antiarrhythmic drugs (AADs) used post-cardioversion to maintain sinus rhythm (SR) is not well-established.
• Choosing the optimal AAD is crucial for preventing AF recurrence and improving patient outcomes.

Purpose of the Study:

• To investigate and compare the efficacy of different AADs in maintaining SR after electrical cardioversion for AF.
• To evaluate the time to AF recurrence and other clinical outcomes associated with various AADs.

Main Methods:

• A retrospective analysis of 265 patients undergoing electrical cardioversion for AF between January 2012 and June 2016.
• Patients were categorized into four groups based on AADs: flecainide, propafenone, amiodarone, and dronedarone.
• Primary outcome: time to AF recurrence within the first year; secondary outcomes included early recurrence, readmissions, and need for non-pharmacological rhythm control.

Main Results:

• No significant difference in AF recurrence-free survival at one year was observed among the four AAD groups (ranging from 67.2% to 80.0%).
• Approximately half of all AF recurrences occurred within the first month post-cardioversion.
• No significant differences were found in secondary outcomes, though amiodarone showed a trend towards increased non-pharmacological rhythm control interventions.

Conclusions:

• Flecainide, propafenone, amiodarone, and dronedarone demonstrate comparable efficacy in maintaining SR after electrical cardioversion for AF.
• AAD type was not a significant predictor of recurrence in multivariate analysis.
• The similar efficacy suggests a potential need to reconsider routine amiodarone use, given its potential side effect profile compared to other agents.