June 1, 1988European Heart Journal
Acute conversion of atrial fibrillation to sinus rhythm: clinical efficacy of flecainide acetate. Comparison of two regimens
Why the study?
Does oral flecainide acetate compare to intravenous flecainide acetate in acute conversion of atrial fibrillation to sinus rhythm in patients with recent onset or chronic atrial fibrillation?
Population
40 patients with atrial fibrillation, classified into recent onset and chronic
Comparison
Oral flecainide acetate (up to 400 mg in 3 h) vs Intravenous flecainide acetate
Design
RCT, Randomly assigned
Follow-up
Up to 5 hours
Authors
Discussion
Loading...
Member takes
Implication
Supports flecainide (oral or IV) for acute conversion in recent-onset AF but not chronic; confirms duration-dependent efficacy.
Key Points
- To evaluate and compare the efficacy and safety of oral versus intravenous flecainide acetate regimens for acute conversion of atrial fibrillation to normal sinus rhythm.
- Randomized trial evaluating 40 patients stratified by recent-onset (<24 hours, n=27) versus chronic (>24 hours, n=13) atrial fibrillation.
- Patients were randomly allocated to receive either oral flecainide (up to 400 mg over 3 hours) or intravenous flecainide (up to 150 mg over 10 minutes).
- Acute conversion was defined as restoration of sinus rhythm within 5 hours for the oral route or within 30 minutes for the intravenous route.
- In recent-onset atrial fibrillation, acute conversion occurred in 10 of 14 patients (71.4%) on oral flecainide and 10 of 13 patients (76.9%) on intravenous flecainide, with roughly half converting during the initial dose or infusion.
- In chronic atrial fibrillation, 0 of 13 patients achieved conversion to sinus rhythm under either flecainide regimen.
- No serious adverse effects were observed with either route of administration, including among patients receiving concomitant digitalis or verapamil.
Structured PICO
Does oral flecainide acetate compare to intravenous flecainide acetate in acute conversion of atrial fibrillation to sinus rhythm in patients with recent onset or chronic atrial fibrillation?
P
Population
40 patients with atrial fibrillation, classified into recent onset (duration <24 h, n=27) and chronic (duration >24 h, n=13)
I
Intervention
Oral flecainide acetate (up to 400 mg in 3 h)
C
Comparator
Intravenous flecainide acetate (up to 150 mg in 10 min)
O
Outcome
Acute conversion to sinus rhythm (defined as conversion within 5 h for oral or within 30 min for intravenous regimen)surrogate
Both oral and intravenous flecainide are highly effective and safe for acute conversion of recent-onset atrial fibrillation, but are ineffective for chronic atrial fibrillation.
Cite This Study
Crijns et al. (1988) studied this question.