Document Detail

Quinidine for pharmacological cardioversion of atrial fibrillation: a retrospective analysis in 501 consecutive patients.
MedLine Citation:
PMID:  19419397     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although quinidine has been used to terminate atrial fibrillation (AFib) for a long time, it has been recently classified to be used as a third-line-drug for cardioversion. However, these recommendations are based on a few small studies, and there are no data available of a larger modern patient population undergoing pharmacological cardioversion of AFib. Therefore, we evaluated the safety of quinidine for cardioversion of paroxysmal AFib in patients after cardiac surgery and coronary intervention. METHODS: In 501 consecutive patients (66 +/- 9 years, 32% women), 200-400 mg of quinidine were administered every 6 hours until cardioversion or for a maximum of 48 hours. Patients were included with QT interval < or =450 ms, ejection fraction (EF) > or =35%, and plasma potassium >4.3 mEq/L. Exclusion criteria were: unstable angina, myocardial infarction <3 months, and advanced congestive heart failure. Patients received verapamil, beta-blockers, or digitalis to slow down ventricular rate <100 bpm. RESULTS: Quinidine therapy did not have to be stopped due to adverse drug reactions (ADR), and no significant QTc interval prolongation (Bazett and Fridericia correction) and no life-threatening ventricular arrhythmia occurred. Mean quinidine dose was 617 +/- 520 mg and 92% of the patients received verapamil or beta-blocker to decrease ventricular rate. Cardioversion was successful in 84% of patients. All ADRs were minor and transient. Multivariate analysis revealed female gender (OR 2.62, CI 1.61-4.26, P < 0.001) and EF 45-54% (OR 1.97, CI 1.15-3.36, P = 0.013) as independent risk factors for ADRs. CONCLUSIONS: Quinidine for pharmacological cardioversion of AFib is safe and well tolerated in this subset of patients.
Bernhard Schwaab; Alexander Katalinic; Uta Maria Böge; Jürgen Loh; Peter Blank; Tatjana Kölzow; Dirk Poppe; Hendrik Bonnemeier
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  14     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-07     Completed Date:  2009-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  128-36     Citation Subset:  IM    
Department of Cardiology and Cardiovascular Rehabilitation, Curschmann Klinik, Timmendorfer Strand, Germany.
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MeSH Terms
Anti-Arrhythmia Agents / adverse effects,  therapeutic use*
Atrial Fibrillation / drug therapy*
Electrocardiography / methods
Odds Ratio
Quinidine / adverse effects,  therapeutic use*
Retrospective Studies
Risk Factors
Treatment Outcome
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 56-54-2/Quinidine

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