Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Short Communication

Volume 9, Number 3, June 2018, pages 165-170

Revisiting the Role of Antiarrhythmic Drugs in Prevention of Atrial Fibrillation Recurrence: A Single Center Retrospective Review

**Table 1.** Baseline Clinical Characteristics of the Patients
Baseline characteristics	Total patient cohort	Sotalol group	Amiodarone group	Propafenone group	Flecainide group
Total patients	145	66 (45.52 %)	65 (44.83%)	12 (8.28%)	2 (1.37 %)
Sex: female	74(51.03%)	31 (21.38%)	31 (21.38%)	11(7.59%)	1 (0.68 %)
Mean age (years) ± SD	77 ± 6.73	72.45 ± 9.33	81.03 ± 6.32	67.44 ± 3.77	65.5 ± 8.5
History of coronary artery disease	89 (61.38%)	47 (32.41%)	39 (26.90%)	3 (2.07%)	0
History of moderate to severe valvular heart disease	24 (16.55%)	12 (8.28%)	11 (7.59%)	0	1 (0.68%)
Hypertension	139 (95.86%)	63 (43.45%)	62 (42.75 %)	12 (8.28%)	2 (1.38%)
Diabetes mellitus	26 (22.61%)	14 (12.17%)	10 (8.70%)	2 (1.74%)	0
Type of AF(paroxysmal versus persistent)	Paroxysmal 134 (92.41%); Persistent 11(7.59%)	Paroxysmal 61 (42.06%); Persistent 5(3.45%)	Paroxysmal 59 (40.69%); Persistent 6 (4.14%)	Paroxysmal 12 (8.28%); Persistent 0	Paroxysmal 2 (1.38%); Persistent 0
Ejection fraction (%)	56.72 ± 8.21	56.69 ± 8.29	57.17 ± 8.37	58.63 ± 5.80	54.5 ± 6.36

Table 1. Baseline Clinical Characteristics of the Patients

Baseline characteristics

Total patient cohort

Sotalol group

Amiodarone group

Propafenone group

Flecainide group

Total patients

145

66 (45.52 %)

65 (44.83%)

12 (8.28%)

2 (1.37 %)

Sex: female

74(51.03%)

31 (21.38%)

11(7.59%)

1 (0.68 %)

Mean age (years) ± SD

77 ± 6.73

72.45 ± 9.33

81.03 ± 6.32

67.44 ± 3.77

65.5 ± 8.5

History of coronary artery disease

89 (61.38%)

47 (32.41%)

39 (26.90%)

3 (2.07%)

History of moderate to severe valvular heart disease

24 (16.55%)

12 (8.28%)

11 (7.59%)

1 (0.68%)

Hypertension

139 (95.86%)

63 (43.45%)

62 (42.75 %)

12 (8.28%)

2 (1.38%)

Diabetes mellitus

26 (22.61%)

14 (12.17%)

10 (8.70%)

2 (1.74%)

Type of AF(paroxysmal versus persistent)

Paroxysmal 134 (92.41%); Persistent 11(7.59%)

Paroxysmal 61 (42.06%); Persistent 5(3.45%)

Paroxysmal 59 (40.69%); Persistent 6 (4.14%)

Paroxysmal 12 (8.28%); Persistent 0

Paroxysmal 2 (1.38%); Persistent 0

Ejection fraction (%)

56.72 ± 8.21

56.69 ± 8.29

57.17 ± 8.37

58.63 ± 5.80

54.5 ± 6.36

**Table 2.** Antiarrhythmic Drugs Used
Antiarrhythmic drug	Basic criteria of initial choice	Main adverse effects monitored
LVEF: left ventricular ejection fraction; LFT: liver function test; CHF: congestive heart failure. Cardiac arrhythmias included but not limited to: QT prolongation, torsades, new or exacerbation of ventricular arrhythmias, atrioventricular block and bradycardia.
Amiodarone	Age > 75 years, age < 75 years with renal insufficiency, reduced LVEF, as an alternative to failed first choice agent	Arrhythmias, LFT derangement, pulmonary toxicity, skin reaction, thyroid dysfunction, hypotension
Sotalol	Age 65 - 75 years with normal renal function as first preference, as an alternative to failed first choice agent	Arrhythmias, bronchospasm, lupus like reaction, CHF, avoided in aortic stenosis due to LVH
Propafenone	Age < 65 years	Arrhythmias, CHF, myasthenia gravis exacerbation, agranulocytosis
Flecainide	Age < 60 years as first preference in absence of structural heart disease	Arrhythmias, CHF

Table 2. Antiarrhythmic Drugs Used

Antiarrhythmic drug

Basic criteria of initial choice

Main adverse effects monitored

LVEF: left ventricular ejection fraction; LFT: liver function test; CHF: congestive heart failure. Cardiac arrhythmias included but not limited to: QT prolongation, torsades, new or exacerbation of ventricular arrhythmias, atrioventricular block and bradycardia.

Amiodarone

Age > 75 years, age < 75 years with renal insufficiency, reduced LVEF, as an alternative to failed first choice agent

Arrhythmias, LFT derangement, pulmonary toxicity, skin reaction, thyroid dysfunction, hypotension

Sotalol

Age 65 - 75 years with normal renal function as first preference, as an alternative to failed first choice agent

Arrhythmias, bronchospasm, lupus like reaction, CHF, avoided in aortic stenosis due to LVH

Propafenone

Age < 65 years

Arrhythmias, CHF, myasthenia gravis exacerbation, agranulocytosis

Flecainide

Age < 60 years as first preference in absence of structural heart disease

Arrhythmias, CHF

**Table 3.** Comparatively Showing Number of Patients and Mean Duration of First AF Recurrence
AF recurrence	Sotalol	Amiodarone	Propafenone	Flecainide	Combined class IC (propafenone + flecainide)	Combined class III (amiodarone + sotalol)
Number of patients with recurrence (N)	17	13	3	1	4	30
Mean duration of first AF recurrence ± SD (months)	18 ± 14.85	17.38 ± 9.90	21.33 ± 22.81	18.5 ± 0	20.63 ± 18.68	17.69 ± 12.37

Table 3. Comparatively Showing Number of Patients and Mean Duration of First AF Recurrence

AF recurrence

Sotalol

Amiodarone

Propafenone

Flecainide

Combined class IC (propafenone + flecainide)

Combined class III (amiodarone + sotalol)

Number of patients with recurrence (N)

Mean duration of first AF recurrence ± SD (months)

18 ± 14.85

17.38 ± 9.90

21.33 ± 22.81

18.5 ± 0

20.63 ± 18.68

17.69 ± 12.37

**Table 4.** Statistical Significance for Primary End Point Among AADs
	Sotalol vs. amiodarone	Sotalol vs. propafenone	Sotalol vs. class IC	Amiodarone vs. propafenone	Amiodarone vs. class IC	Class III vs. class IC
NS: statistically not significant. P < 0.05 was considered statistically significant.
P-value for duration of first AF recurrence	0.90 (NS)	0.75 (NS)	0.77 (NS)	0.63 (NS)	0.64 (NS)	0.68 (NS)

Table 4. Statistical Significance for Primary End Point Among AADs

Sotalol vs. amiodarone

Sotalol vs. propafenone

Sotalol vs. class IC

Amiodarone vs. propafenone

Amiodarone vs. class IC

Class III vs. class IC

NS: statistically not significant. P < 0.05 was considered statistically significant.

P-value for duration of first AF recurrence

0.90 (NS)

0.75 (NS)

0.77 (NS)

0.63 (NS)

0.64 (NS)

0.68 (NS)

**Table 5.** Different Average Daily Dose of AADs and Recurrence of AF
AADs	Recurrence of AF	Non-recurrence of AF	P-value
Sotalol
Number of patients	17	49
Mean daily dose (mg): mean ± SD	146.38 ± 30.04	209.18 ± 83.54	< 0.05
Amiodarone
Number of patients	13	52
Mean daily dose (mg): mean ± SD	151.65 ± 87.71	217.34 ± 66.85	< 0.05
Propafenone
Number of patients	3	9
Mean daily dose (mg): mean ± SD	716.67 ± 115.47	805.56 ± 88.19	> 0.05

Table 5. Different Average Daily Dose of AADs and Recurrence of AF

AADs

Recurrence of AF

Non-recurrence of AF

P-value

Sotalol

Number of patients

Mean daily dose (mg): mean ± SD

146.38 ± 30.04

209.18 ± 83.54

< 0.05

Amiodarone

Number of patients

Mean daily dose (mg): mean ± SD

151.65 ± 87.71

217.34 ± 66.85

< 0.05

Propafenone

Number of patients

Mean daily dose (mg): mean ± SD

716.67 ± 115.47

805.56 ± 88.19

> 0.05