Pharmacological conversion of persistent atrial fibrillation into sinus rhythm with oral pilsicainide: pilsicainide suppression trial for persistent atrial fibrillation II.

Abstract

BACKGROUND:

The present study was conducted to determine the antiarrhythmic efficacy and safety of oral pilsicainide, a class Ic antiarrhythmic drug, in patients with persistent atrial fibrillation (AF).

METHODS AND RESULTS:

One hundred and eight patients (mean age, 58.9 years) with AF lasting >or=48 h and <or=6 months were randomized to receive pilsicainide 50 mg t.i.d. (n=58) or placebo (n=50) for 2 weeks in a double-blinded fashion. All patients underwent appropriate anticoagulation therapy with warfarin for >or=3 weeks prior to the study enrolment or after verification of the absence of left atrial thrombi by transesophageal echocardiography. After 2 weeks of treatment, an electrocardiogram was recorded to determine whether sinus rhythm was restored. Sinus rhythm was restored in 22.4% of patients treated with pilsicainide and in 2% treated with placebo (p=0.002). Cardioversion was less likely to occur with oral pilsicainide when the AF duration exceeded 2 months or if the left atrial diameter exceeded 45 mm. There was no significant difference in the adverse cardiovascular event rate between the pilsicainide- and placebo-treated groups. One patient in the pilsicainide group developed an atrial flutter without any hemodynamic deterioration.

CONCLUSION:

A 2-week oral administration of pilsicainide is well tolerated and moderately effective in converting persistent AF into sinus rhythm.

• Authors: Kaoru Okishige, Masatake Fukunami, Koichiro Kumagai, Hirotsugu Atarashi, Hiroshi Inoue, Pilsicainide Suppression Trial for Persistent Atrial Fibrillation II Investigators
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 70 Issue 6 Pg. 657-61 (Jun 2006) ISSN: 1346-9843 [Print] Japan
• PMID: 16723783 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Anti-Arrhythmia Agents
• Anticoagulants
• Warfarin
• Lidocaine
• pilsicainide

Topics

• Administration, Oral
• Adult
• Aged
• Anti-Arrhythmia Agents (administration & dosage, adverse effects)
• Anticoagulants (administration & dosage)
• Atrial Fibrillation (drug therapy)
• Contraindications
• Double-Blind Method
• Female
• Humans
• Lidocaine (administration & dosage, adverse effects, analogs & derivatives)
• Male
• Middle Aged
• Recovery of Function (drug effects)
• Remission Induction
• Thrombosis (etiology, prevention & control)
• Warfarin (administration & dosage)