December 2, 2004
Como, Italy- In-hospital
administration of flecainide and propafenone has been shown to
be safe and effective in terminating atrial fibrillation.
Treatment with either flecainide or propafenone administered as
a single dose outside the hospital was given to terminate atrial
fibrillation of recent onset. This study, published by Paolo
Alboni, M.D., Giovanni L Botto, M.D., et. al., in the December
2, 2004 issue of the New England Journal of Medicine , shows
this “pill-in-the-pocket” approach to be feasible and safe, in
view of the high rate of patient compliance and the low
incidence of adverse effects.
of antiarrhythmic agents and associated adverse effects are
disadvantages of long-term prophylaxis. Some patients have
recurrent atrial fibrillation that is infrequent,
well-tolerated, but long enough in duration that they require
emergency room or hospital intervention. For these patients,
oral prophylaxis or catheter ablation may not be appropriate.
Thus, the “pill-in-the-pocket”, a single dose of antiarrhythmic
drug with onset of symptoms, seems feasible and safe.
administration of flecainide or propafenone to 268 patients with
mild or no heart disease was given to patients who came to the
emergency room with atrial fibrillation of recent onset. Of
these patients, 58 (22%) were excluded from the study because of
treatment failures or side effects. In the remaining 210
patients, out-of-hospital self-administration of flecainide or
propafenone – the “pill-in-the-pocket” approach was given after
the onset of heart palpitations.
All patients who
had been treated successfully in the hospital, defined by not
having conversion to sinus rhythm within six hours of drug
administration, were instructed to take the drug five minutes
after the onset of subsequent palpitations.
During a mean
follow-up of 15 +/- 5 months, 165 patients (79%) had a total of
618 episodes of arrhythmia. The drug was effective for 534 of
569 episodes (94 %; corrected efficacy, 93%; 95% confidence
interval, 90 to 95). The mean time for resolution of symptoms
after the ingestion of the drug was 113 +/- 84. Flecainide was
effective in 239 of 254 episodes (94%) and propafenone in 295 of
315 (94%). The drug was effective during all the arrhythmic
episodes in 139 patients (84%). The number of monthly visits to
the emergency room and hospitalizations were significantly lower
during follow-up than during the year before the target episode
shows that in a selected, risk-stratified population of patients
with recurrent atrial fibrillation, “pill-in-the-pocket”
treatment is feasible and safe, with a high rate of compliance
by patients, a low rate of adverse events and a marked reduction
in emergency room visits and hospital admissions.
Alboni, M.D., Giovanni L Botto, M.D., Nicola Baldi, M.D., Mario
Luzi, M.D., Vitantonia Russo, M.D., Lorella Gianfranchi, M.D.,
Paola Marchi, M.D., Massimo Calzolari, M.D., Alberto Solano,
M.D., Rafaele Baroffio, M.D. and Germano Gaggioli, M.D.