Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials.
Key result
Quinidine therapy maintained sinus rhythm at 12 months better than control (50% vs 25%, p<0.001) but increased total mortality (2.9% vs 0.8%; OR 2.98, p<0.05).
Why the study?
Does quinidine therapy improve maintenance of sinus rhythm after cardioversion in patients with chronic atrial fibrillation?
Population
808 patients from 6 randomized control trials after cardioversion from chronic atrial fibrillation
Comparison
Quinidine therapy vs Control group (no antiarrhythmic therapy)
Design
Meta-analysis, randomized control trials
Follow-up
12 months
Authors
Discussion
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Implication
Quinidine should be avoided for post-cardioversion AF rhythm control due to excess mortality; challenges historical use of class Ia agents.
Study Design
Type
Meta-Analysis (n=808)
Structured PICO
Does quinidine therapy improve maintenance of sinus rhythm after cardioversion in patients with chronic atrial fibrillation?
P
Population
808 patients from 6 randomized control trials (published 1970-1984) after cardioversion from chronic atrial fibrillation
I
Intervention
Quinidine therapy
C
Comparator
Control group (no antiarrhythmic therapy)
O
Outcome
Maintenance of sinus rhythm at 3, 6, and 12 months after cardioversion
Main Result
Effect estimate: Rate difference 24%
Absolute Event Rate: 50% vs 25%
p-value: p=<0.001
While quinidine effectively maintains sinus rhythm after cardioversion, it significantly increases total mortality compared to no antiarrhythmic therapy.
Cite This Study
Coplen et al. (1990) conducted a meta-analysis in Chronic atrial fibrillation (n=808). Quinidine vs. Control (no antiarrhythmic therapy) was evaluated on Maintenance of sinus rhythm at 12 months (Rate difference 24%, p=<0.001). Quinidine therapy maintained sinus rhythm at 12 months better than control (50% vs 25%, p<0.001) but increased total mortality (2.9% vs 0.8%; OR 2.98, p<0.05).