VErapamil plus antiarrhythmic drugs reduce atrial fibrillation recurrences after an electrical cardioversion (VEPARAF study)

Antonio De Simone, Michele De Pasquale, Carmine De Matteis, Michelangelo Canciello, Michele Manzo, Luigi Sabino, Ferdinando Alfano, Michele Di Mauro, Andrea Campana, Giuseppe De Fabrizio, Dino Franco Vitale, Pietro Turco, Giuseppe Stabile

Research output: Contribution to journalArticlepeer-review


Aims: To evaluate the impact, on atrial fibrillation (AF) recurrences, of verapamil addition to a class IC or III antiarrhythmic drug in patients, with persistent AF, who underwent an electrical cardioversion (EC). Methods and results: Three hundred sixty-three patients were randomized to receive four different pre-treatment protocols: oral amiodarone (group A), oral flecainide (group F), oral amiodarone plus oral verapamil (group A+V), oral flecainide plus oral verapamil (group F+V). Patients who showed an AF recurrence within 3 months were assigned to the alternative group and underwent a second EC after 48 h. During 3 months of follow-up, 89 patients (27.5%) had an AF recurrence. By univariate analysis, verapamil reduced AF recurrences if added to amiodarone or flecainide (from 35% to 20%, P=0.004). Applying Cox proportional hazards regression model, only the younger age, the shorter duration of AF, and the use of verapamil were predictor of maintenance of sinus rhythm after cardioversion. In patients with primary AF recurrence, verapamil addition to group A and F patients, significantly decreased secondary AF recurrence rate as compared to group A+V and F+V patients who stopped the verapamil therapy (68% vs 88%, P=0.03). Conclusions: The addition of verapamil to class IC or III antiarrhythmic drug significantly reduced the AF recurrences, that were more frequent in older patients and in patients with longer lasting AF; moreover, verapamil was effective in reducing the secondary AF recurrences, too.

Original languageEnglish
Pages (from-to)1425-1429
Number of pages5
JournalEuropean Heart Journal
Issue number15
Publication statusPublished - Aug 2003


  • Antiarrhythmia agents
  • Cardioversion
  • Fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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