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European Heart Journal Advance Access published online on February 28, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl544
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study

Anna K Nergårdh*, Mårten Rosenqvist, Rolf Nordlander{dagger} and Mats Frick

Department of Cardiology, Karolinska Institutet at Stockholm South Hospital, Stockholm S-118 83, Sweden

Received 14 July 2006; revised 18 December 2006; accepted 25 January 2007.

* Corresponding author. Tel: +46 8616 30 88; fax: +46 8616 30 40. E-mail address: anna.nergardh{at}sodersjukhuset.se

Aims: To assess the effect of metoprolol in combination with repeated cardioversion on maintenance of sinus rhythm (SR).

Methods and results: Consecutive outpatients with persistent atrial fibrillation (AF) were randomized to treatment with metoprolol CR or placebo in a double-blind fashion. Study treatment was started at least one week before direct current (DC) cardioversion. Patients were followed once a week during the first 6 weeks after cardioversion. In case of relapse during this period, a second cardioversion was performed. Total treatment time was 6 months. A total of 168 patients were randomized to metoprolol (n = 83) or placebo (n = 85). The dose of study treatment at cardioversion was 169 ± 47 mg in the metoprolol group and 180 ± 40 mg in the placebo group (P = 0.12). In an intention-to-treat analysis, 46 patients (55%) in the metoprolol group and 34 patients (40%) in the placebo group (P = 0.04) had SR 1 week after cardioversion, and 38 patients (46%) in the metoprolol group compared with 22 patients (26%) in the placebo group had SR after 6 months (P < 0.01).

Conclusion: A treatment strategy of metoprolol CR started before cardioversion in combination with prompt second cardioversion in case of early relapse (1–6 weeks) significantly increases the proportion of patients in SR during six months of follow-up.

Key Words: Atrial fibrillation • Cardioversion • Metoprolol • Arrhythmias

{dagger} Deceased 3 June 2006.


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