Researchers at the Johns Hopkins University School of Medicine have just released a major study aimed at determining the effectiveness of heart drugs in converting atrial fibrillation to sinus rhythm and in maintaining sinus rhythm in AF patients. They looked at the results of 36 major clinical trials and reached the conclusion that ibutilide/dofetilide and flecainide (Tambocor) are the most effective drugs when it comes to converting AF to sinus rhythm. Ibutilide/dofetilide was 29 times more effective than placebo and flecainide 25 times more effective. Verapamil, diltiazem (Cardizem) and digoxin (Lanoxin) were all found to be essentially useless; that is, no better than placebo. So while these drugs may be helpful in slowing the heartbeat, they are ineffective in converting it to normal sinus rhythm. Propafenone (Rythmol) and quinidine (Biquin) were much less effective and sotalol (Sotacor, Betapace) actually had a negative effect. None of the drugs evaluated were particularly effective in maintaining sinus rhythm; that is, preventing another attack. Quinidine, disopyramide (Rythmodan), flecainide, propafenone, and sotalol all showed some positive effect while verapamil, diltiazem and digoxin had no beneficial effects.

In this issue we report on the latest findings regarding the factors determining the outcome of chemical and electrical cardioversion and the complications commonly associated with these procedures. We also report that catheter ablation with uninterrupted warfarin therapy is safer and more successful than the current warfarin/heparin protocol, that alcohol is an important trigger for the first and subsequent AF episodes, that the chance of a successful ablation outcome declines the more antiarrhythmics a patient has tried prior to the ablation, that there are new concerns about the WATCHMAN device for stroke prevention, and that a Norwegian study discovers new risk factors for AF and lone AF.

Enjoy!!

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Wishing you good health and lots of NSR,