What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic rheumatic atrial fibrillation following mitral valve replacement (n=25). Intervention: Oral flecainide. Primary outcome: Maintenance of sinus rhythm at 6 months.

What question did this study set out to answer?

To evaluate the efficacy, safety, and predictors of success for oral flecainide in converting and maintaining sinus rhythm among patients with chronic rheumatic atrial fibrillation after mitral valve replacement.

July 18, 2023Indian Heart JournalOpen Access

Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillation

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Key result

Oral flecainide safely maintained sinus rhythm at 6 months in 69.5% of patients with chronic rheumatic atrial fibrillation following mitral valve replacement.

Why the study?

Many patients remain in AF despite successful MVR, and flecainide could be useful but has not been used due to underlying structural heart disease.

Does oral flecainide improve conversion and maintenance of sinus rhythm in patients with chronic rheumatic atrial fibrillation following mitral valve replacement?

Population

25 patients with chronic rheumatic AF following MVR

Comparison

Oral flecainide for conversion and maintenance of SR

Follow-up

6 months

Authors

UTUmesh TripathiKing George's Medical University AKAditya KapoorUniversity of Nebraska–Lincoln SASurendra Kumar AgarwalSanjay Gandhi Post Graduate Institute of Medical Sciences

Discussion

Member takes

Implication

May support flecainide for SR maintenance post-MVR in rheumatic AF; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

To evaluate the efficacy, safety, and predictors of success for oral flecainide in converting and maintaining sinus rhythm among patients with chronic rheumatic atrial fibrillation after mitral valve replacement.
Enrolled 25 patients with chronic rheumatic atrial fibrillation (mean age 34.4 years, mean atrial fibrillation duration 3.6 years) who had undergone mitral valve replacement.
Administered single-dose oral flecainide, followed by direct current cardioversion at 24 hours and 4 weeks for non-converters, discharging patients on flecainide and rate-control therapy.
Tracked 6-month sinus rhythm maintenance, electrophysiological safety parameters, functional status, and echocardiographic measures including left atrial strain.
Single-dose flecainide converted 6/25 (24%) patients to sinus rhythm, and 21/25 (84%) achieved sinus rhythm by 24 hours after direct current cardioversion; 16/23 (69.5%) maintained sinus rhythm at 6 months with mean flecainide dose 93.10 ± 9.40 mg.
Patients maintaining sinus rhythm achieved significantly higher left atrial strain at 6 months (25.25% vs 17.43%, p < .0001) without adverse widening of PR, QRS, or QTc intervals.
Baseline left atrial diameter ≤ 61 mm (sensitivity 93.7%, specificity 85.71%), atrial fibrillation duration ≤ 4 years (87.5%, 71.43%), and left atrial strain > 21% (100%, 85.71%) predicted sinus rhythm maintenance at 6 months.

Study Design

Type

Cohort (n=25)

Structured PICO

Does oral flecainide improve conversion and maintenance of sinus rhythm in patients with chronic rheumatic atrial fibrillation following mitral valve replacement?

Population

25 patients (mean age 34.4 years) with chronic rheumatic atrial fibrillation following mitral valve replacement, followed for 6 months.

Intervention

Oral flecainide (single oral dose for conversion, followed by mean dose 93.10 ± 9.40 mg for maintenance) plus beta-blocker/diltiazem at discharge. Non-converters underwent DC cardioversion at 24 hours and 4 weeks.

Outcome

Conversion and maintenance of sinus rhythm at 6 monthssurrogate

Oral flecainide appears safe and effective for converting and maintaining sinus rhythm in patients with chronic rheumatic atrial fibrillation after mitral valve replacement, despite traditional concerns regarding its use in structural heart disease.

Cite This Study

Tripathi et al. (2023) conducted a cohort in Chronic rheumatic atrial fibrillation following mitral valve replacement (n=25). Oral flecainide was evaluated on Maintenance of sinus rhythm at 6 months. Oral flecainide safely maintained sinus rhythm at 6 months in 69.5% of patients with chronic rheumatic atrial fibrillation following mitral valve replacement.

synapsesocial.com/papers/6a71db15f44fa9f079df8a36 https://doi.org/10.1016/j.ihj.2023.07.001

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF AF ablation outcomes

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Implication

May support flecainide for SR maintenance post-MVR in rheumatic AF; hypothesis-generating and requires randomized confirmation before practice change.

Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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Topics

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