| Popis: |
Chronic atrial fibrillation (AF) is a ommon arrhythmia with significant morbidity and mortality. The antiarrhythmic effects of amiodarone (AM) and flecainide (FLEC) in patients with resistant chronic AF have been studied separately in several small clinical trials. This study compared AM to FLEC in maintaining normal sinus rhythm (NSR) in patients (pts) with resistant chronic AF. To facilitate the comparison, quinidine (QUIN) was used as the reference standard. Studies using AM or FLEC in the treatment of chronic AF refractory to either Class I AF drugs or sotalol were identified. The results of 6 trials of AM (200–400 mg/day; 315 pts) and 2 trials of FLEC (200–300 mg/day; 163 pts) were aggregated using meta-analysis in NSR at 3 and 12 mos for AM and FLEC were compared relative to corresponding results for QUIN, which were acquired from a meta-analysis of OUIN used as first-line therapy for AF. Duration of chronic AF ranged from 2 wks to 25 yrs. After 3 and 12 mos of treatment with AM, 217 of 299 (72.6%) and 64 of 107 (59.8%) pts, respectively, remained in NSR. These percentages were significantly greater (p l 0.00011 when compared to OUIN at these time points (70% and 50%, respectively). After 3 and 12 mos of treatment with FLEC, the percentage of pts remaining in NSR were significantly lower (p l 0.00011 than OUIN: 79 of 163 (48.5%) and 56 of 163 (34%) pts, respectively. The aggregated percentages of pts requiring withdrawal of AM and FLEC were 9.5% and 8.6%, respectively. Mortality and proarrhythmia could not be assessed. Conclusion This analysis suggests that low-dose AM is more efficacious and equally well-tolerated when compared to FLEC in the management of chronic, drug-resistant AF. |
