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

Antonio De Simone, Giuseppe Stabile, Dino Franco Vitale, Pietro Turco, Maurizio Di Stasio, Ferdinando Petrazzuoli, Maurizio Gasparini, Carmine De Matteis, Raffaele Rotunno, Tommaso Di Napoli

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)810-814
Number of pages5
JournalJournal of the American College of Cardiology
Issue number3
Publication statusPublished - Sep 1999

ASJC Scopus subject areas

  • Nursing(all)


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