Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension

Capucci, Alessandro; Lenzi, Tiziano; Boriani, Giuseppe; Trisolino, G.; Binetti, Nicola; Cavazza, Mario; Fontana, Giovanni; Magnani, B

doi:10.1016/0002-9149(92)91392-h

Cited by 203 publications

(80 citation statements)

References 27 publications

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“…Pharmacological cardioversion seems to be mostly effective when initiated within first week of the onset of an AF episode (10,11). A large proportion of patients with recent-onset AF experience spontaneous cardioversion within 24 to 48 hours after AF onset (12,13).…”

Section: Discussionmentioning

confidence: 99%

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Balla¹,

Petrela²,

Kondili³

2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Atriyal fibrilasyonun (AF) sinüs ritmine döndürülmesi çoğu kez emboli riskini ve hemodinamik bozulmanın azaltılması için yapılır. Bu çalışmada, son 48 saat içinde AF geçirmiş hastalar üzerinde tek oral doz flekainid, amiyodaron ve propafenon ile atriyal fibrilasyonun sinüs ritmine dönüşümü üzerindeki etkileri plasebo ile randomize olarak karşılaştırılmıştır. Yöntemler: Bu çalışma 160 hasta üzerinde yapılmış, hastalara rastgele olmak üzere flekainid (3 mg/kg, n=40), amiyodaron (30 mg/kg, n=40), propafenon (8.5 mg/kg, n=40) veya placebo (n=40) verilmiştir. Amaçlanan nokta ilaç alınımı sonrası 24 saat içinde AF'nin sinüs ritmine dönüşüm hızı olmuştur. AF konversiyon oranı ile 3 antiaritmik ilacın kullanımı ile ilişkiler çoklu lojistik regresyon analiz ile değerlendirilmiştir. Bulgular: Amaçlanan etki, flekainid kullanan hastaların %87.5'inde, amiyodaron kullanan hastaların %85'inde, propafenon kullanan hastaların 85%'inde, plasebo kullanan hastaların ise %17.5'inde (p<0.001 her 3 ilacın plasebo ile karşılaştırılması) gerçekleşmiştir. İlaç alımından 3 saat sonraki dönüşüm hızı, amiodaron (%0) ve plasebo (%10) ile karşılaştırıldığında; Propafenon grubunda (%57.5) ve flekainid grubunda (%45) olmak üzere daha yüksek bulunmuştur. Amiyodaron kullanan hastalar 6 ve 24 saat içinde, flekainid veya propafenon grubu hastalara göre anlamlı olarak daha fazla sinüs ritmine döndürülmüştür. Plasebo ile kıyaslandığında antiaritmik ilaçların kullanımı sinüs ritmine dönüştürmede belirgin derecede üstün bulundu (düzeltilmiş OR=19.53, %95 GA 3.14-121.55, p<0.001). Önemli yan etki gözlenmedi. Sonuç: Atriyal fibrilasyona yakın zamanda girmiş hastalarda oral ilaç alımını izleyen 24 saatlik süreç içinde sinüs ritmine geri döndürmede flekainid, amiyodaron veya propafenon grubu, plasebo grubuna göre üstün bulunmuştur. Propafenon ve flekainid'in oral alım sonrası ilk 3 saat içinde amiyodaron'a göre daha etkili olmakla birlikte her 3 antiaritmik ilaç benzer etkinliktedir. (Anadolu Kardiyol Derg 2011; 11: 600-6) Anahtar kelimeler: Amiyodaron, atriyal fibrilasyon, flekainid, propafenon, sinüs ritm, lojistik regresyon analizi ABSTRACT Objective: In this study, we randomly compared single oral doses of flecainide, amiodarone and propafenone versus placebo for the conversion of recent atrial fibrillation (AF) (within 48 hours). Methods: This is a randomized prospective, placebo-controlled single-blind study that included 160 consecutive patients with recent AF who were randomly assigned to single oral doses of flecainide (3 mg/kg of weight, n=40), amiodarone (30 mg/kg weight, n=40), propafenone (8.5 mg/ kg of weight, n=40) or placebo (n=40). The primary end-point was conversion rate at 24 hours after the drug intake. The association between antiarrhythmic use and conversion rate was tested with multiple logistic regressions. Results: The primary end-point was achieved in 87.5% of patients with flecainide, 85% of patients with amiodarone, 85% of patients with propafenone and 17.5% of patients with placebo (p<0.001 compared with placebo for...

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Section: Discussionmentioning

confidence: 99%

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Balla¹,

Petrela²,

Kondili³

2011

Anadolu Kardiyol Derg

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“…A single loading dose of oral flecainide at 300mg had a superior conversion efficacy to placebo (91% vs. 48%) and amiodarone (91% vs. 37%) in 8 hours [51].…”

Section: Class Ic Antiarrhythmic Medications Flecainidementioning

confidence: 92%

“…[18,[50][51][52][53][54], Martinez-Marcos et al found the median time to conversion to be 25 minutes with a range of 4-660 minutes.…”

Section: Class Ic Antiarrhythmic Medications Flecainidementioning

confidence: 99%

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

En¹,

Sk²

2017

Cardiovasc Pharm Open Access

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Introduction: Cardiac arrhythmias, including supraventricular and ventricular tachycardias, portend a higher risk of morbidity and mortality. These arrhythmias also are associated with increased healthcare resource utilization, decreased quality of life, and increased activity impairment. Pharmacologic conversion is a treatment option for conversion to sinus rhythm that has the advantage of avoiding sedation from DC cardioversion.

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“…For recent onset AF, many patients convert spontaneously within 48 h of onset. 8 No study has directly compared pharmacologic with electrical cardioversion; electrical cardioversion appears to be more efficacious. Drugs with proven efficacy when administered within 7 days include dofetilide, ibutilide, propafenone, flecainide, amiodarone, and quinidine.…”

Section: Treatment (Fig 1)mentioning

confidence: 99%

Concise review of atrial fibrillation: Treatment update considerations in light of AFFIRM and RACE

Bloom

2004

Clinical Cardiology

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Summary: Atrial fibrillation (AF) is the most common clinically significant arrhythmia seen by clinicians. Prevalence is as high as 9.0% in patients aged ≥ 80 years, and incidence is projected to be more than 5.6 million patients in the U.S. by 2050. Recently, new trials have challenged the traditional belief that rhythm control is inherently superior to rate control in these patients. This article reviews the basic tenets of treatment for AF and discusses how new trial data integrate into these protocols. A concise treatment algorithm is provided and new and upcoming more aggressive interventional treatment options are discussed. This review is designed to help the general practitioner decide how to treat patients in the outpatient setting, evaluate which patients should be hospitalized for management, and which patients should be referred to a cardiologist.

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Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension

Cited by 203 publications

References 27 publications

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

Concise review of atrial fibrillation: Treatment update considerations in light of AFFIRM and RACE

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