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Use of Flecainide for the Treatment of Atrial Fibrillation

Although it is recommended in current medical guidelines as first-line therapy for patients without structural heart disease, the use of flecainide has been curtailed since the completion of the Cardiac Arrhythmia Suppression Trial. In clinical trials and real-world use, flecainide has proven to be more effective than other AADs for the acute termination of recent onset AF. Flecainide is also moderately effective and, with the exception of amiodarone, equivalent to other AADs for the chronic suppression of paroxysmal and persistent AF. In patients without structural heart disease, flecainide has been demonstrated to be safe and well tolerated relative to other AADs. Despite this favorable…

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 A “Pill-in-the-Pocket” Approach to Paroxysmal Atrial Fibrillation

The “pill-in-the-pocket” approach is the administration of a prescribed class IC antiarrhythmic, either flecainide or propafenone, following recent onset of episodes of palpitations in patients with paroxysmal AF. It is generally initiated by the patient’s cardiologist after extensive cardiac evaluation to rule out structural disease and other conduction abnormalities. The idea is to terminate the suspected episode of AF without having to present to an ED or clinic. Several studies have investigated the safety of this approach and supported this method of outside-the-hospital termination of paroxysmal AF events.

Articles of Interest

Atrial Fibrillation and Flecainide - Safety, Effectiveness and Quality of Life Outcomes

Flecainide is a class IC antiarrhythmic agent indicated for patients with atrial fibrillation without any evidence of structural heart disease. This brief review of four recent studies on flecainide focuses on safety aspects, efficacy and the debate on impact on quality of life in this patient population.

Flecainide: A Pill In The Pocket For AFib

The most commonly used dose of flecainide for a pill-in-the pocket technique is 200-300mg for a single dose.

Resources

Flecainide

In patients without structural heart disease, flecainide acetate tablets, USP are indicated for the prevention of — paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms. paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms...

StatPearls

Flecainide acetate is an oral class Ic antiarrhythmic drug (AAD) which blocks cardiac Na+ channels and received FDA approval in 1984. Flecainide is used in paroxysmal supraventricular tachycardia (PSVTs), including atrioventricular nodal re-entrant tachycardia (AVNRT), AV re-entrant tachycardia (AVRT), and atrial fibrillation/atrial flutter in patients who do not have structural heart disease.