title: Flecainide in quinidine-resistant atrial fibrillation.
abstract: Flecainide (100 mg twice daily) was used for prevention of paroxysmal atrial fibrillation (PAF) in 52 patients with frequent symptomatic attacks that were resistant or intolerant to quinidine (600-900 mg/day). Underlying heart disease was present in only 8 cases and left ventricular ejection fraction was always greater than 30%. No patient had had a myocardial infarction. Vagally induced PAF was clinically documented in 35 patients. Amiodarone, previously used and ineffective, was combined with flecainide in 33 patients. After 1-5.8 years of follow-up, complete disappearance of PAF was observed in 38 patients (73%). The success rate was slightly higher in patients with vagally induced PAF (p = 0.07). Extracardiac side effects necessitated withdrawal in only 3 cases. Permanent pacemaker was needed in 7 patients on amiodarone and flecainide because of excessive sinus bradycardia. Two patients, with previously documented atrial flutter, experienced presyncopal episodes of atrial flutter with 1:1 atrioventricular (AV) conduction and wide QRS complex. No death occurred during the follow-up. In this series, quinidine proved to be unsuccessful in 46 patients and it was withdrawn in 6. We concluded that flecainide is efficient and well tolerated for long-term prevention of PAF in patients resistant to quinidine. The possibility of 1:1 AV conduction during atrial flutter may suggest the use of verapamil or beta blockers in combination with flecainide in patients with previously documented atrial flutter.
authors.affiliation: Department of Cardiology, Lariboisière University Hospital, Paris, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Leclercq
authors.forename: F
authors.initials: F
authors.lastname: Chouty
authors.forename: I
authors.initials: I
authors.lastname: Denjoy
authors.forename: P
authors.initials: P
authors.lastname: Coumel
authors.forename: R
authors.initials: R
authors.lastname: Slama
mesh_terms: D000638:Amiodarone / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D015716:Electrocardiography, Ambulatory; D005260:Female; D005424:Flecainide / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011802:Quinidine / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D011802:Quinidine; D005424:Flecainide; D000638:Amiodarone