Abstract
Background: A number of patients with persistent atrial fibrillation (AF) will not have sinus rhythm (SR) restored by direct current (DC) cardioversion.
Hypothesis: In patients with DC‐refractory AF, oral pretreatment with sotalol increases the success rate at DC cardioversion.
Methods: Consecutive patients with persistent AF, refractory at a first DC cardioversion, were prospectively included. A comparative group of patients with AF not refractory at DC cardioversion was studied. Oral sotalol treatment was started after unsuccessful DC cardioversion and given at least 7 days before renewed cardioversion. Four weeks after cardioversion, an electrocardiogram was performed.
Results: In all, 53 patients were enrolled in the study. Forty‐three (81%) in the sotalol group regained sinus rhythm (SR): 10 (19%) of these converted pharmacologically and 33 (62%) after a second DC cardioversion; SR was never restored in 10 patients (19%). After 4 weeks, SR was maintained in 29 patients (67%). The comparative group included 132 patients and differed significantly from the DC‐refractory patients only with regard to weight. After 4 weeks, SR was maintained by 50 patients (37%) in this group.
Conclusions: In patients with persistent AF refractory to DC cardioversion, oral pretreatment with sotalol results in a high rate of SR restoration, either pharmacologically or by DC cardioversion. Maintenance of SR at 4 weeks is of sufficient clinical relevance to consider this treatment option in patients with AF refractory to DC cardioversion.
Keywords: atrial fibrillation, cardioversion, sotalol, arrhythmias
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