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CLINICAL STUDIES

Pretreatment with verapamil in patients with persistent or chronic atrial fibrillation who underwent electrical cardioversion

Antonio De Simone, MD^a, Giuseppe Stabile, MD^a, Dino Franco Vitale, MD, Pietro Turco, MD^a, Maurizio Di Stasio, MD, Ferdinando Petrazzuoli, MD^a, Maurizio Gasparini, MD, Carmine De Matteis, MD, Raffaele Rotunno, MD^|| and Tommaso Di Napoli, MD^||

^a Laboratorio di Elettrofisiologia, Casa di Cura "San Michele," Maddaloni, Italy
Dipartimento di Geriatria, Università degli Studi di Napoli "Federico II," Napoli, Italy
Istituto Clinico "Humanitas," Rozzano, Italy
Servizio di Riabilitazione, Ospedale Civile di Arienzo, Arienzo, Italy
^|| Unità Coronarica, Ospedale Civile di Polla, Polla, Italy

Manuscript received November 24, 1998; revised manuscript received April 7, 1999, accepted May 10, 1999.

Reprint requests and correspondence: Dr. Giuseppe Stabile, Laboratorio di Elettrofisiologia, Casa di Cura S. Michele, Via Appia 178, 81024 Maddaloni, Italia
stabigiu{at}usa.net

OBJECTIVES

To evaluate, in a prospective and randomized fashion, the efficacy of a pretreatment with verapamil (V) in reducing recurrences of atrial fibrillation (AF) after electrical cardioversion (C).

BACKGROUND

The increased vulnerability for AF recurrence is probably due to AF-induced changes in the electrophysiologic properties of the atria. This electrical remodeling seems to be due to intracellular calcium overload.

METHODS

One hundred seven patients with persistent or chronic AF underwent external and/or internal C. All patients received oral propafenone (P) (900 mg/day) three days before and during the entire period of follow-up (three months). In the first group, patients received only the P. In the second group, in adjunct to P, oral V (240 mg/day) was initiated three days before C and continued during the follow-up. Finally, in the third group, oral V was administered three days before and continued only for three days after electrical C.

RESULTS

During the three months of follow-up, 23 patients (23.7%) had AF recurrence. Mantel-Haenszel cumulative chi-square reached a significant level only when comparing AF free survival curves of group I versus group II and group III (chi-square = 5.2 and 4, respectively; p < 0.05). Significantly, 15 (65.2%) AF relapses occurred during the first week after cardioversion with a higher incidence in group I (10/33 patients, 30.3%) than group II (2/34 patients, 5.9%; p = 0.01) and group III (3/30 patients, 10%; p = 0.04).

CONCLUSIONS

Six days of oral V administration centered on the C day, combined with P, significantly reduce the incidence of early recurrences of AF compared with P alone.

Abbreviations and Acronyms   AF = atrial fibrillation   ECG = electrocardiogram

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