Successful Conversion of Recent‐onset Atrial Fibrillation by Sequential Administration of up to Three Antiarrhythmic Drugs

Background Short‐term conversion attempt of recent‐onset atrial fibrillation (AF) in the emergency room fails too often. Many patients and doctors still prefer pharmacological to electrical solutions in such cases. Hypothesis Sequential administration of up to 3 antiarrhythmic drugs of different classes of action (amiodarone, propafenone, and quinidine) may achieve conversion in such patients. Method One hundred and forty consecutive patients with recent‐onset AF were transferred to the intensive cardiac care unit after a failed 2‐h conversion attempt in the emergency room. First‐line drug for conversion was continued up to a full dose, and was chosen by AF etiology, or in recurrent AF episodes, empirically. In nonresponders, the failed drug was replaced by a drug of another class, and if the second‐line drug failed it was replaced by a drug of the third‐line. Electrical cardioversion was the final solution for nonresponders. Results Sixty percent of patients reached sinus rhythm by the first‐line drug therapy, 34% by the second‐line, and 4% by the third‐line. Seventy‐five percent of patients achieved conversion within 26 h, and 95% of patients achieved conversion within 40 h. Three patients were electrically cardioverted due to hemodynamical instability. Two episodes of Torsade de Pointes ventricular tachycardia were self‐terminated. Conclusion Sequential usage of up to 3 antiarrhythmic drugs of different classes of action provides almost complete success in conversion of recent‐onset AF in patients refractory to short‐term conversion attempt in the emergency room. Copyright © 2008 Wiley Periodicals, Inc.