Efficacy of Procainamide vs Amiodarone for Atrial Fibrillation in Emergency Department Patients
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Publication Date
2025
Keywords
oregon, oaa 2025, ppmc
Disciplines
Cardiology | Emergency Medicine | Medical Education | Pharmacy and Pharmaceutical Sciences
Abstract
Abstract: Procainamide has been shown to be safe and effective for atrial fibrillation, and it has a rapid onset to cardioversion. However, its efficacy compared to amiodarone is not well-characterized. Current literature suggests that procainamide may have a faster time to conversion than amiodarone. The purpose of this study is to compare rate and time to conversion of atrial fibrillation to normal sinus rhythm (NSR) between procainamide and amiodarone in emergency department (ED) patients. The potential to discharge patients more quickly and lessen ED burden is especially important in the era of ED overcrowding. This is a retrospective, propensity-matched, multi-center, observational study. Adult patients who received procainamide or amiodarone for atrial fibrillation/flutter in the ED at a Providence Hospital in the Oregon region from 2014 to 2024 were included. Patients were identified and screened through the use of EPIC Hyperspace and Slicer Dicer. Descriptive statistics were utilized to compare baseline characteristics. Rate of conversion to NSR and other categorical variables were compared with the chi-square test. Time to conversion to NSR and other continuous variables were compared with Student’s t-test. Linear or logistic regression analysis will be conducted to determine factors significantly associated with rate and/or time to conversion to NSR. Preliminary results were gathered with 22 patients receiving procainamide and 19 patients receiving amiodarone. There was no significant difference between incidence of atrial fibrillation (91.0% vs 78.9%) vs atrial flutter (9.0% vs 2.1%) between procainamide and amiodarone groups, respectively (p = 0.28). There was no significant difference between paroxysmal (50.0% vs 73.7%) vs new-onset (50.0% vs 26.3%) atrial fibrillation/flutter between procainamide and amiodarone groups, respectively (p = 0.062). Fifty percent of patients converted on procainamide, and 57.9% of patients converted on amiodarone (p = 0.613). For patients that did not convert to NSR, subsequent electrical cardioversion was successful in 100% of patients on procainamide and 26.3% of patients on amiodarone (p = 0.154). Time to conversion appeared to be shorter with procainamide (7.14 hours) vs amiodarone (16.4 hours), though this result did not achieve statistical significance likely due to lack of power (p = 0.069). Length of stay was significantly shorter in the procainamide group compared to the amiodarone group (10.1 vs 27.5 hours, p = 0.0059). Significantly more patients in the procainamide group were discharged from the ED compared to the amiodarone group (86.0% vs 31.6%, p < 0.001). Final conclusions will be shared when the formal analysis is completed. (IRB approved) Learning objectives: 1) Describe the impact of procainamide vs amiodarone on time to discharge for patients who present to ED with atrial fibrillation/flutter, 2) Compare the safety and effectiveness of procainamide versus amiodarone for atrial fibrillation/flutter Presentation Category: Cardiology/Emergency Medicine
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Pharmacy
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Emergency Medicine
