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Evidence that class IA antiarrhythmics such as quinidine may increase mortality in patients with atrial fibrillation has fostered a search for alternatives. This meta-analysis of seven prospective studies compared amiodarone with flecainide in patients with chronic atrial fibrillation resistant to class I antiarrhythmic drugs or sotalol.
A total of 315 patients in six studies received amiodarone (200-400 mg daily), and 163 patients in two studies received flecainide (200-300 mg daily). After three months, 73% of patients treated with amiodarone and 49% of those treated with flecainide had achieved and maintained normal sinus rhythm. After 12 months, 60% and 34% of patients, respectively, still had normal sinus rhythm. Rates of withdrawal due…