Intravenous Flecainide for Emergency Department Management of Acute Atrial Fibrillation

Use of Flecainide for the Treatment of Atrial Fibrillation

“…65 A meta-analysis of randomized studies found the overall AF conversion rate within 2 hours to be higher with flecainide (66%) compared with the AADs amiodarone, propafenone, sotalol, procainamide, and ibutilide (46%). 38 Randomized studies directly comparing flecainide AF conversion rates with dofetilide and vernakalant are not available; however, in studies with a placebo comparator, the conversion rates were lower than reported for flecainide. 66 Thus, acute conversion of recent onset AF is higher with flecainide than any other antiarrhythmic agent.…”

“…35−37 Hemodynamic Effects Flecainide has negative inotropic properties. Intravenous (IV) administration of flecainide, even in patients without structural heart disease hearts, can cause hypotension, 38 and/ or reduced stroke volume and cardiac output. 39 In patients with coronary artery disease, IV flecainide has been reported to reduce stroke volume, cardiac output, and ejection fraction; and increase pulmonary capillary wedge pressure, especially in those with concomitant left ventricular (LV) dysfunction.…”

“…The lower conversion rates observed in 2 studies 56,57 are likely due to the shorter end point times at which conversion efficacy was assessed. In a meta-analysis of 6 studies, 38 with a conversion end point time of 2 hours, IV flecainide administration was associated with a 69% conversion rate compared with 16% with placebo or verapamil. Figure 1.…”

“…A large meta-analysis of 122 studies 94 that included both acute and chronic treatment with flecainide for supraventricular tachyarrhythmias found that the incidence of all arrhythmia-related adverse events with flecainide was significantly lower than that of active comparators and placebo controls (2.5% vs 3.2%, p <0.001). A more recent meta-analysis of studies on acute AF conversion 38 found that the incidence of arrhythmia-related adverse events was similar for IV flecainide, placebo, amiodarone, propafenone, sotalol, dofetilide, and ibutilide. The same study reported that the risk of hypotension with IV flecainide was statistically significantly higher than with placebo but not higher than with other AADs.…”

“…Major adverse events Relative incidence* Acute conversion 38,[56][57][58][59]68,69,91 Sudden cardiac death, ventricular tachyarrhythmia Rare 1:1 atrial flutter Unusual Bradyarrhythmia, sinus pause, heart block Unusual Hypotension Occasional (mostly with IV) Chronic prevention 54,71,72,74,85,86 Sudden cardiac death, ventricular tachyarrhythmia Rare 1:1 atrial flutter Unusual Bradyarrhythmia, sinus pause, heart block Unusual Worsened heart failure Rare * Rare <1%, Unusual 1% to <3%, Occasional 3% to <10%, Frequent ≥10%.…”