Does cibenzoline prevent recurrence of symptomatic paroxysmal atrial fibrillation better than pilsicainide depending on the duration of arrhythmia before therapy?
Cibenzoline, a multichannel blocker, is more effective than the pure sodium-channel blocker pilsicainide in preventing recurrence of paroxysmal atrial fibrillation in patients with prolonged arrhythmia (>=48 hours) prior to cardioversion.
BACKGROUND: There is little information on the selection of antiarrhythmic agents for long-term prevention of paroxysmal atrial fibrillation (PAF). In the present study the preventive effects of pilsicainide (Pil) and cibenzoline (Cib) were compared in patients with PAF that was defibrillated at or=48 h after onset. METHODS AND RESULTS: A total of 60 patients (45 men, 15 women, mean age 66+/-10 years) were divided into 2 groups: Group I consisted of 22 patients in whom atrial fibrillation (AF) lasted for or=48 h. A randomized, crossover protocol of treatment with Pil (150 mg/day) and Cib (300 mg/day) was used. Mean follow-up was 35+/-18 months. In Group I, the mean duration of maintenance of sinus rhythm was 12.3+/-2.9 months in patients treated with Pil, compared with 12.9+/-2.5 months in those givem Cib (p=NS between 2 groups). Actuarial event-free rates at 1, 3, 6, 12 months were 82%, 68%, 59% and 41%, respectively, in patients treated with Pil, and 91%, 77%, 68% and 50%, respectively, in those givenh Cib (p=NS between 2 groups). In Group II, the mean duration of maintenance of sinus rhythm was 1.6+/-0.5 months in patients treated with Pil, compared with 5.9+/-1.7 months in those given Cib (por=48 h) in patients with PAF seems to cause electrical remodeling. Cib, a multichannel blocker, is considered to be more effective in preventing the recurrence of PAF in the electrically remodeled atria than Pil, a pure sodium-channel blocker.
Komatsu et al. (Sun,) studied this question.