title: Flecainide for cardioversion in patients at elevated cardiovascular risk and persistent atrial fibrillation: a prospective observational study.
abstract: BACKGROUND
  Flecainide is used as a pill-in-the-pocket treatment for pharmacological cardioversion in patients without structural heart disease and atrial fibrillation (AF). In patients with structural heart disease and elevated cardiovascular risk, flecainide is believed to be harmful. Therefore, data about safety and effectiveness of single-dose flecainide for cardioversion in patients at elevated cardiovascular risk are lacking.
  
  
  OBJECTIVE
  One-hundred and six consecutive patients with recent onset AF and known structural heart disease and/or elevated PROCAM-score did receive oral flecainide 300 mg for cardioversion.
  
  
  METHODS
  The effectiveness, safety and influencing factors of flecainide for cardioversion in high-risk patients were prospectively assessed.
  
  
  RESULTS
  In 43 of 106 patients (40.6%), sinus rhythm could be restored within 192.4 +/- 10.7 min by flecainide. The PROCAM-score was 41.5 +/- 0.56 in patients with successful cardioversion compared to 45.7 +/- 0.74 in patients without successful cardioversion (P < 0.001). ACE-inhibitor co-medication was associated with a significantly lower rate of conversion by flecainide (HR 2.3, 95% CI, 1.12-4.26, P < 0.01). In 58 of 63 patients in whom cardioversion by flecainide was not effective, electrical cardioversion was performed which was successful in 47 patients. Life-threatening arrhythmias did not occur in any patient. The most common side effect was sinus-bradycardia and transient sinus arrest (2-4 s) immediately after conversion.
  
  
  CONCLUSIONS
  When monitored properly, flecainide is safe and useful for cardioversion in patients at elevated cardiovascular risk.
authors.affiliation: Department of Internal Medicine III, Heart Center of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. Fikret.Er@uk-koeln.de
authors.forename: Fikret
authors.initials: F
authors.lastname: Er
authors.forename: Orhan
authors.initials: O
authors.lastname: Aslan
authors.forename: Evren
authors.initials: E
authors.lastname: Caglayan
authors.forename: Natig
authors.initials: N
authors.lastname: Gassanov
authors.forename: Amir M
authors.initials: AM
authors.lastname: Nia
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Rosenkranz
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D004554:Electric Countershock; D005260:Female; D005424:Flecainide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D005424:Flecainide