Copyright © 2003 by the European Society of Cardiology.
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VErapamil Plus Antiarrhythmic drugs Reduce Atrial Fibrillation recurrences after an electrical cardioversion (VEPARAF Study)
a Casa di Cura S. Michele (CE), Maddaloni, Italy
b Clinica del Sole, Salerno, Italy
c Ospedale Civile di Arienzo (CE), Town, Italy
d Ospedale Loreto Mare, Napoli, Italy
e Ospedale Ruggi D'Aragona, Salerno, Italy
f Ospedale Civile di Marcianise (CE), Town, Italy
g Ospedale Moscati, Avellino, Italy
h Fondazione S. Maugeri IRCCS, (BN), Telese T, Italy
* Correspondence to: Giuseppe Stabile, Casa di Cura San Michele, Via Appia, 176 81024 Maddaloni (CE), Italy. Tel: 0823/208503; fax: 0823/402474
E-mail address: gmrstabile{at}tin.it
Received 14 October 2002; revised 2 May 2003; accepted 21 May 2003
Aims To evaluate the impact, on atrial fibrillation (AF) recurrences, of verapamil addition to a class IC or III antiarrhythmic drug in patients, with persistent AF, who underwent an electrical cardioversion (EC).
Methods and results Three hundred sixty-three patients were randomized to receive four different pre-treatment protocols: oral amiodarone (group A), oral flecainide (group F), oral amiodarone plus oral verapamil (group A+V), oral flecainide plus oral verapamil (group F+V). Patients who showed an AF recurrence within 3 months were assigned to the alternative group and underwent a second EC after 48h. During 3 months of follow-up, 89 patients (27.5%) had an AF recurrence. By univariate analysis, verapamil reduced AF recurrences if added to amiodarone or flecainide (from 35% to 20%, P=0.004). Applying Cox proportional hazards regression model, only the younger age, the shorter duration of AF, and the use of verapamil were predictor of maintenance of sinus rhythm after cardioversion. In patients with primary AF recurrence, verapamil addition to group A and F patients, significantly decreased secondary AF recurrence rate as compared to group A+V and F+V patients who stopped the verapamil therapy (68% vs 88%, P=0.03).
Conclusions The addition of verapamil to class IC or III antiarrhythmic drug significantly reduced the AF recurrences, that were more frequent in older patients and in patients with longer lasting AF; moreover, verapamil was effective in reducing the secondary AF recurrences, too.
Key Words: Fibrillation • Antiarrhythmia agents • Cardioversion
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