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Abstract
The efficacy and safety of the single dose oral loading regimen of propafenone for
pharmacological cardioversion of recent-onset atrial fibrillation (AFib) was evaluated
by analyzing the trials on the subject identified through a comprehensive literature
search. Most of the trials used a single dose of 600 mg for oral loading. The success
rates ranged from 56% to 83%, depending on the duration of AFib and follow-up after
drug administration. The conversion time ranged from 110 +/- 59 to 287 +/- 352 min,
depending on the duration of observation after drug administration. The single dose
oral loading regimen of propafenone was significantly more efficacious than placebo
in the first 8 h after administration but not at 24 h. Compared with the intravenous
regimen, the oral regimen resulted in fewer conversions in the first 2 h, but both
regimens were equally efficacious afterward. The oral propafenone regimen was as efficacious
as the single dose oral loading regimen of flecainide but was superior to those of
quinidine and amiodarone. The adverse effects reported were transient arrhythmia,
reversible QRS-complex widening, transient hypotension and mild noncardiac side effects.
The transient arrhythmias were chiefly at the time of conversion and included appearance
of atrial flutter, bradycardia, pauses and junctional rhythm. No life-threatening
proarrhythmic adverse effects were reported. The single oral loading dose of propafenone
appears to be highly effective for conversion of recent-onset AFib, with a relatively
rapid effect within 2 to 3 h and freedom from serious adverse effects.