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[Acute atrial fibrillation in the emergency room. Which is the best drug for a rapid sinus rhythm conversion?].

PURPOSE
To evaluate differences between amiodarone, procainamide and quinidine in the time delay necessary to convert acute atrial fibrillation (AF) to sinus rhythm.


METHODS
Sixty patients with acute AF were randomized in three groups (G) and treated with: quinidine (QG)-(21 patients) i.v. digital + quinidine up to 600 mg; procainamide (PG)-(23 patients) i.v. digital + i.v. procainamide, 10 mg/kg; amiodarone (AG)-(16 patients) i.v. amiodarone, 5 mg/kg. To evaluate time delay to conversion, all patients have their rhythm recorded by Holter system during four hours. Statistics were done with x2, considering significant a p < 0.05.


RESULTS
There were no differences between groups regarding to age, gender and delay from symptoms initiation and medical assistance. Conversion to sinus rhythm occurred, in QG-71.4% cases; PG-47.8% and AG-50% (p > 0.05). Time delay in minutes to conversion were, respectively (media +/- SD): QG-112 +/- 43; PG-44.1 +/- 28; AG-20 +/- 13, significantly lower in PG and AG related to QG (p = 0.001). Although not significant, side effects were observed mostly in PG.


CONCLUSION
Amiodarone is a good choice to convert, very quickly, acute AF. Otherwise, quinidine has the best rate of conversion but with a longer time delay.