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Outpatient Treatment of Recent-Onset Atrial fibrillation with Flecainide and Propafenone Has Been Shown to be Safe and Feasible in Terminating Atrial Fibrillation 

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. 

Daily administration 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. 

Initially, oral 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 (p< 0.001) 

These results 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. 

Co-authors: Paolo 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. 

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