Heart 1999;82:170-175 ( August )

An open label, randomised, crossover study comparing sotalol and atenolol in the treatment of symptomatic paroxysmal atrial fibrillation

R P Steeds^a, A S Birchall^a, M Smith^b, K S Channer^a

^a Department of Cardiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK, ^b Department of Medical Physics, Rotherham District General Hospital, Moorgate Road, Rotherham, South Yorkshire S60 2UD, UK

Correspondence to: Dr Channer.

Accepted for publication 3 March 1999

OBJECTIVETo compare sotalol and atenolol in the treatment of symptomatic paroxysmal atrial fibrillation.
DESIGNProspective, randomised, open label, crossover study.
SETTINGUniversity hospital.
PATIENTS47 subjects aged over 50 years were recruited from the hospital outpatient department following ECG documentation of paroxysmal atrial fibrillation that coincided with symptoms. Six patients withdrew and 41 completed the trial.
INTERVENTIONSPatients were randomised to one month's treatment with sotalol 80 mg twice daily or atenolol 50 mg once daily. Treatment arms were then crossed over. Patients underwent 72 hour Holter monitoring before randomisation and repeat studies were carried out at the end of both treatment periods. Symptom assessments were completed using linear analogue scales and the Nottingham health profile.
MAIN OUTCOME MEASUREFrequency of paroxysmal atrial fibrillation; secondary outcome measures included average and total duration of paroxysmal atrial fibrillation, total ectopic count, and symptom assessments.
RESULTSA reduction in the number and duration of episodes of paroxysmal atrial fibrillation was noted following treatment with sotalol and atenolol. There was no difference in frequency of paroxysmal atrial fibrillation during treatment with sotalol or atenolol (median difference 0; 95% confidence interval (CI) 0 to 1; p = 0.47). There was no difference in total duration of paroxysmal atrial fibrillation (median difference 0 min; 95% CI 1 to 2; p = 0.51) or in average duration (median difference 0 min; 95% CI 0 to 1; p = 0.31). No difference was found in total ectopic count between sotalol and atenolol (median difference 123; 95% CI 362 to 135; p = 0.14). Treatments were equally tolerated with no difference in linear analogue scores for symptoms of paroxysmal atrial fibrillation (median difference 5; 95% CI 20 to 5; p = 0.26) or in all categories of the Nottingham health profile.
CONCLUSIONSNo difference was found in terms of ECG or symptomatic control of paroxysmal atrial fibrillation between prescribing sotalol 80 mg twice daily and atenolol 50 mg once daily. There was an improvement in paroxysmal atrial fibrillation from baseline following treatment with either sotalol or atenolol.


Keywords: paroxysmal atrial fibrillation; sotalol; atenolol

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© 1999 by Heart
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