Aim: To compare efficacy and safety of amiodarone, propafenone and flecainide in treating recent-onset AF in acute setting.
Methods: Out of patients observed from January 2009 to December 2011 for recent-onset AF in our Emergency Department, we considered only those with first attempt at cardioversion and without clinical conditions forcing pharmacological strategy. Depending on physician’s choice, patients received a bolus of amiodarone 4 mg/kg or propafenone 2 mg/kg or flecainide 2 mg/kg.
Results: A number of 302 patients with homogenous baseline characteristics (157 males, 145 females, mean age 60.4 years) were considered in this study. At the end of 12-hours observation period, conversion to sinus rhythm was achieved in 51.5% of patients in amiodarone, 76.2% in propafenone and 89.1% in flecainide group (flecainide and propafenone vs amiodarone p<0.0001). Median time to cardioversion was significantly shorter in flecainide and propafenone than in amiodarone group (p<0.0001). We reported an overall very low incidence of adverse events. Need for hospitalization resulted higher in amiodarone group (p<0.001).
Conclusions: Flecainide and propafenone resulted more effective and as safe than amiodarone in acute management of AF.