Some patients with paroxysmal atrial fibrillation should carry flecainide or propafenone to self treat

Atrial fibrillation affects up to 1.5% of the population in the United Kingdom,1 about 200 000 of whom have recurrent episodes. Although such episodes often resolve spontaneously and within 48 hours,2 patients may be distressed by symptoms of palpitations, dizziness, fatigue, or chest pain. Such attacks generally respond to antiarrhythmic agents (such as a single intravenous dose of propafenone or flecainide),3 which are usually administered under monitoring in hospital. Here we propose that patients could self treat with oral propafenone or flecainide, using a “pill in the pocket” approach (thereby not needing to go to hospital), as suggested in recent national (National Institute for Health and Clinical Excellence) and international guidelines.4 5 For details of our methods, please see the box on bmj.com. #### KEY POINTS #### Methods Our proposal is based on: