disease. N Engl J Med 1983;309:385-389. 5. Kottke BA, Zinsmeister AR, Holmes DR, Kneller RW, Hallaway BJ, Mao SJT. Apolipoproteins and coronary artery disease. Mayo C/in Proc 1986;61:313m 320. 6. Genest JJ, Corbett AM, McNamara JR, Schaefer MM, Salem DN, Schaefer EJ. Effect of hospitalization on high-density lipoprotein cholesterol in patients undergoing elective coronary angiography. Am J Cardiol 1988;61:998-1000 7. Wolinsky H. The effect of beta-adrenergic blocking agents on blood lipid levels. Clin Cardiol 1987:10:56/~566. 8. Ryder REJ, Hayes TM, Mulligan IP, Kingswood JC, Williams S, Owens DR. How soon after myocardial infarction should plasma lipid values be assessed. Br Med J 1984;289:165/-1653.
intravenous Amiodarone Versus of Paroxysmal Atrial Fibrillation Marko Not,
MD,
9. McNamara JR, Schaefer EJ. Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. C/in Chim Acta /987:166:/~8. 10. Ordovas JM, Peterson JP, Santaniello P, Cohn JS, Wilson PWF, Schaefer EJ. Enzyme-linked immunosorbent assay for human plasma apolipoprotein B. ./ Lipid Res 1987;28:1216-1224. 11. McNamara JR, Campus H, Adolphson JL, Ordovas JM. Wilson PWF, Albers JJ, Usher DC, Schaefer EJ. Screening for lipoprotein(a) elevations and assessment of size heterogeneity using gradient gel electrophoresis. J Lipid Res 1989;30:747-755. 12. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults. Arch Intern Med 1988:118:36-69.
Verapamil for Acute to Sinus Rhythm
Conversion
Dusan Stajer, MD, and Matija Horvat, MD, PhD
miodarone and verapamil are well-known antiarrhythmic drugs used for treatment of ventricular A and supraventricular arrhythmias. Although verapamil is the drug of choice for control of the atrioventricular node, it has also been reported to terminate atria1 fibrillation.‘-3 Amiodarone has been used extensively for drug-refractory ventricular tachycardia but seldom for termination of paroxysmal atria1 fibrillation.4-6 To our knowledge, no comparative study with amiodarone and verapamil has been reported. Because of this, we compared the efficacy of intravenous amiodarone versus verapamil for conversion of paroxysmal atria1 fibrillation to sinus rhythm in a single-blind randomized study. The patient population consisted of 24 consecutive patients with paroxysmal atFia1 ftbFillatiOn (I 5 men and 9 women aged 71 f 9.6 years, range 51 to 85). The duration of arrhythmia Fanged fFOi?I 20 minutes to 48 hours at entry to the study. The mean ventricular rate was 12.5 f 27 beatslmin. There was no statistically significant difference in age, sex, heart rate, duration of arrhythmia before arrival and incidence of different heart disease between the amiodarone and verapamil groups. Exclusion criteria were known OFsuspected conduction disturbances, including preexcitation; sick sinus syndrome; hyperthyroidism; concomitant therapy with antiarrhythmic drugs: arrhythmia-related systemic arterial hypotension; and any sign of heart failure. Medical history, clinical examination, routine laboratory testing and a I2-lead electrocardiogram wereperformed. Informed consent was obtained and patients were treated with either amiodarone (5 mg/kg body weight intravenously over a 3-minute period) OF verapamil(O.075 mg/kg intravenously over a 1-minute period, repeated after 10 minutes). Whether the patient received amiodarone OF verapamil was determined randomly. Treatment was considered successful if conversion occurred within 3 hours after administration of the drug. An alternative drug was given and observation time was prolonged for an additional 3 hours, but only if the initially randomized drug failed to convert the atria1 From the Center for Intensive Internal Medicine, University Clinical Center Ljubljana, Zaloska 7,610OO Ljubljana, Yugoslavia. Manuscript received August 23, 1989; revised manuscript received and accepted October 27, 1989.
TABLE I Rate of Conversion Antiarrhythmic Treatment
to Sinus Rhythm Atrial
Amiodarone Verapamil Amiodarone/verapamil Verapamil/amiodarone Total amiodarone Total verapamil -. * p
intravenous Amiodarone Versus of Paroxysmal Atrial Fibrillation Marko Not,
MD,
9. McNamara JR, Schaefer EJ. Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. C/in Chim Acta /987:166:/~8. 10. Ordovas JM, Peterson JP, Santaniello P, Cohn JS, Wilson PWF, Schaefer EJ. Enzyme-linked immunosorbent assay for human plasma apolipoprotein B. ./ Lipid Res 1987;28:1216-1224. 11. McNamara JR, Campus H, Adolphson JL, Ordovas JM. Wilson PWF, Albers JJ, Usher DC, Schaefer EJ. Screening for lipoprotein(a) elevations and assessment of size heterogeneity using gradient gel electrophoresis. J Lipid Res 1989;30:747-755. 12. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults. Arch Intern Med 1988:118:36-69.
Verapamil for Acute to Sinus Rhythm
Conversion
Dusan Stajer, MD, and Matija Horvat, MD, PhD
miodarone and verapamil are well-known antiarrhythmic drugs used for treatment of ventricular A and supraventricular arrhythmias. Although verapamil is the drug of choice for control of the atrioventricular node, it has also been reported to terminate atria1 fibrillation.‘-3 Amiodarone has been used extensively for drug-refractory ventricular tachycardia but seldom for termination of paroxysmal atria1 fibrillation.4-6 To our knowledge, no comparative study with amiodarone and verapamil has been reported. Because of this, we compared the efficacy of intravenous amiodarone versus verapamil for conversion of paroxysmal atria1 fibrillation to sinus rhythm in a single-blind randomized study. The patient population consisted of 24 consecutive patients with paroxysmal atFia1 ftbFillatiOn (I 5 men and 9 women aged 71 f 9.6 years, range 51 to 85). The duration of arrhythmia Fanged fFOi?I 20 minutes to 48 hours at entry to the study. The mean ventricular rate was 12.5 f 27 beatslmin. There was no statistically significant difference in age, sex, heart rate, duration of arrhythmia before arrival and incidence of different heart disease between the amiodarone and verapamil groups. Exclusion criteria were known OFsuspected conduction disturbances, including preexcitation; sick sinus syndrome; hyperthyroidism; concomitant therapy with antiarrhythmic drugs: arrhythmia-related systemic arterial hypotension; and any sign of heart failure. Medical history, clinical examination, routine laboratory testing and a I2-lead electrocardiogram wereperformed. Informed consent was obtained and patients were treated with either amiodarone (5 mg/kg body weight intravenously over a 3-minute period) OF verapamil(O.075 mg/kg intravenously over a 1-minute period, repeated after 10 minutes). Whether the patient received amiodarone OF verapamil was determined randomly. Treatment was considered successful if conversion occurred within 3 hours after administration of the drug. An alternative drug was given and observation time was prolonged for an additional 3 hours, but only if the initially randomized drug failed to convert the atria1 From the Center for Intensive Internal Medicine, University Clinical Center Ljubljana, Zaloska 7,610OO Ljubljana, Yugoslavia. Manuscript received August 23, 1989; revised manuscript received and accepted October 27, 1989.
TABLE I Rate of Conversion Antiarrhythmic Treatment
to Sinus Rhythm Atrial
Amiodarone Verapamil Amiodarone/verapamil Verapamil/amiodarone Total amiodarone Total verapamil -. * p
