What is the clinical evidence from this study?

Study design: RCT. Population: Persistent or chronic atrial fibrillation (n=107). Intervention: Verapamil and Propafenone vs. Propafenone alone. Primary outcome: Early recurrences of atrial fibrillation (first week after cardioversion) (p=0.04).

What question did this study set out to answer?

To assess the effectiveness of verapamil pretreatment in lowering atrial fibrillation recurrences after electrical cardioversion.

April 22, 2026

Pretreatment with verapamil in patients with persistent or chronic atrial fibrillation who underwent electrical cardioversion

Key Result

Six days of oral verapamil combined with propafenone significantly reduced early recurrences of atrial fibrillation compared with propafenone alone (10% vs 30.3%, p=0.04).

Key Points

To assess the effectiveness of verapamil pretreatment in lowering atrial fibrillation recurrences after electrical cardioversion.
107 patients with persistent or chronic AF were randomized into three groups: one received propafenone alone, one received propafenone and verapamil before and after cardioversion, and the third group received verapamil before but only for three days post-cardioversion.
Follow-up lasted three months, and all patients received propafenone at a dosage of 900 mg/day.
During the 3-month follow-up, 23 patients (23.7%) experienced AF recurrence, with significant differences in recurrence rates among the groups.
Early AF recurrences were 30.3% in group I (propafenone only), 5.9% in group II (verapamil and propafenone), and 10% in group III (verapamil pre-cardioversion).
Verapamil significantly reduced the incidence of early AF recurrences compared to propafenone alone (p < 0.05).

Study Design

Type

RCT (n=107)

Structured PICO

Does pretreatment with verapamil reduce recurrences of atrial fibrillation after electrical cardioversion in patients with persistent or chronic AF?

Population

107 patients with persistent or chronic atrial fibrillation who underwent external and/or internal electrical cardioversion

Intervention

Oral verapamil (240 mg/day) initiated 3 days before cardioversion and continued either during the 3-month follow-up or for 3 days after cardioversion, added to oral propafenone (900 mg/day)

Comparator

Oral propafenone (900 mg/day) alone, initiated 3 days before cardioversion and continued during the 3-month follow-up

Outcome

Recurrence of atrial fibrillation during the 3 months of follow-uphard clinical

Pretreatment with verapamil combined with propafenone significantly reduces early recurrences of atrial fibrillation after electrical cardioversion compared to propafenone alone.

Main Result

Absolute Event Rate: 10% vs 30.3%

p-value: p=0.04

Abstract

OBJECTIVES: To evaluate, in a prospective and randomized fashion, the efficacy of a pretreatment with verapamil (V) in reducing recurrences of atrial fibrillation (AF) after electrical cardioversion (C). BACKGROUND: The increased vulnerability for AF recurrence is probably due to AF-induced changes in the electrophysiologic properties of the atria. This electrical remodeling seems to be due to intracellular calcium overload. METHODS: One hundred seven patients with persistent or chronic AF underwent external and/or internal C. All patients received oral propafenone (P) (900 mg/day) three days before and during the entire period of follow-up (three months). In the first group, patients received only the P. In the second group, in adjunct to P, oral V (240 mg/day) was initiated three days before C and continued during the follow-up. Finally, in the third group, oral V was administered three days before and continued only for three days after electrical C. RESULTS: During the three months of follow-up, 23 patients (23.7%) had AF recurrence. Mantel-Haenszel cumulative chi-square reached a significant level only when comparing AF free survival curves of group I versus group II and group III (chi-square = 5.2 and 4, respectively; p < 0.05). Significantly, 15 (65.2%) AF relapses occurred during the first week after cardioversion with a higher incidence in group I (10/33 patients, 30.3%) than group II (2/34 patients, 5.9%; p = 0.01) and group III (3/30 patients, 10%; p = 0.04). CONCLUSIONS: Six days of oral V administration centered on the C day, combined with P, significantly reduce the incidence of early recurrences of AF compared with P alone.