Efficacy of flecainide acetate for atrial arrhythmias following coronary artery bypass grafting.
The antiarrhythmic efficacy of intravenous flecainide and intravenous digoxin was assessed in 29 patients (26 men), aged 43 to 73 (63 +/- 7) years who developed atrial arrhythmias in the first 96 hours after coronary artery bypass grafting. Twenty-seven had atrial fibrillation and 2 had atrial flutter. Patients were entered into the study if the arrhythmia persisted for at least 15 minutes with a ventricular rate greater than 120 beats/min. Fifteen patients were randomized to flecainide (group 1) and 14 to digoxin (group 2). Flecainide was given as a bolus of 1 mg/kg over 10 minutes followed by an infusion of 1.5 mg/kg/hr for 1 hour and then 0.25 mg/kg/hr for the rest of the study period (24 hours). Digoxin was given as 3 bolus doses (0.5 mg followed after 6 and 12 hours by 0.25 mg). In both groups, 10 mg of verapamil was given intravenously after 45 minutes if the arrhythmia persisted with a mean ventricular rate greater than 100 beats/min. The antiarrhythmic efficacy was assessed by 24-hour Holter monitoring and frequent 15-second rhythm strips. Within 45 minutes control of arrhythmia, which was maintained for the rest of the study period, was achieved in 10 of 15 patients in group 1 and 2 of 14 in group 2 (p less than 0.01). Nine of 15 reverted to sinus rhythm in group 1 compared to 0 of 14 in group 2 and 1 of 15 remained in arrhythmia with a controlled ventricular rate in group 1 compared to 2 of 14 in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Wafa
S S
SS
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
Ward
D E
DE
Parker
D J
DJ
Camm
A J
AJ
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004077:Digoxin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005424:Flecainide / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D014700:Verapamil / Q000009:adverse effects / Q000627:therapeutic use
D004077:Digoxin; D014700:Verapamil; D005424:Flecainide