title: Combined use of 1C and III agents for highly symptomatic, refractory atrial fibrillation.
abstract: BACKGROUND
  Despite advances in non-pharmacologic therapy for atrial fibrillation (AF), some patients remain highly refractory.
  
  
  OBJECTIVE
  We report our experience with the unique combined use of 1C and III agents in patients with highly refractory paroxysmal atrial fibrillation.
  
  
  METHODS
  Six patients with symptomatic AF (three persistent) were selected after failing multiple antiarrhythmic medications and radiofrequency ablation. They were started on flecainide or propafenone and sotalol or dofetilide during three days of inpatient monitoring. No patient had coronary artery disease. All patients had loop recorder follow-up and ECG recordings during clinic visits for a mean follow-up of 9 +/- 11 months.
  
  
  RESULTS
  After therapy, all patients had complete, sustained control of their symptoms with no evidence of AF or proarrhythmia on monitoring. One patient had recurrence of AF after stopping sotalol and was started back on the drug with complete control.
  
  
  CONCLUSIONS
  Combined therapy with a 1C and III agent may be an effective alternative for the treatment of selective, highly refractory AF. Careful patient selection and hospitalization for initiation is necessary to minimize potential proarrhythmic effects. As this is a short-term therapy, further study is needed to assess the extent of efficacy in a larger number of patients.
authors.affiliation: Electrophysiology Laboratories, Aurora Sinai/St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, WI, USA.
authors.forename: Girish
authors.initials: G
authors.lastname: Narayan
authors.forename: Masood
authors.initials: M
authors.lastname: Akhtar
authors.forename: Jasbir
authors.initials: J
authors.lastname: Sra
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000517:prevention & control*; D002908:Chronic Disease; D004338:Drug Combinations; D005260:Female; D005424:Flecainide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010627:Phenethylamines / Q000008:administration & dosage*; D011405:Propafenone / Q000008:administration & dosage*; D055502:Secondary Prevention; D013015:Sotalol / Q000008:administration & dosage*; D013449:Sulfonamides / Q000008:administration & dosage*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D004338:Drug Combinations; D010627:Phenethylamines; D013449:Sulfonamides; D011405:Propafenone; D013015:Sotalol; D005424:Flecainide; C063533:dofetilide