Table 6 Pharmacological cardioversion in atrial fibrillation

Flecainide

300 mg orally or 2 mg/kg in over 10–30 min for cardioversion Maintenance dose of up to 150 mg twice daily

Hypotension, heart failure, coronary artery disease, proarrhythmia (atrial flutter)

Recommended (class I) for pharmacological cardioversion of recent-onset AF

Propafenone

2 mg/kg or 600 mg orally for cardioversion Maintenance dose up to 300 mg twice daily

Hypotension, heart failure, proarrhythmia (atrial flutter)

Recommended (class I) for pharmacological cardioversion of recent-onset AF

Quinidine

200 mg orally, followed by 400 mg Maintenance dose of up to 400 mg four times daily

Gastrointestinal upset and proarrhythmia

Increased risk for death with long-term use

Sotalol

120–160 mg twice daily

Asthma, bradycardia/heart block, heart failure

Poor cardioversion efficacy Not recommended as first line

Amiodarone

1200 mg intravenous in 24 hours for cardioversion Maintenance dose of 200 mg (lower doses preferred) 30 mg/kg oral loading dose

Bradycardia/heart block, thyroid dysfunction, pulmonary and liver toxicity with long-term use

Effective for cardioversion and maintaining sinus rhythm Onset may be slow Toxic effects with long-term use

Dofetilide [33]

125–500 μg orally twice daily based on renal function and QT_c

QT interval prolongation, ventricular arrhythmias (in particular torsades de pointes), conduction disturbances also recognized

Class III agent for conversion and maintenance of sinus rhythm Risk for ventricular tachyarrhythmias Not licensed for use in UK

Ibutilide [34]

Dependent on patient weight: ≥60 kg, 1 mg intravenous; <60 kg, 0.01 mg/kg intravenous

As per dofetilide

Intravenous equivalent of dofetilide Not licensed for use in UK