title: Flecainide-metoprolol combination reduces atrial fibrillation clinical recurrences and improves tolerability at 1-year follow-up in persistent symptomatic atrial fibrillation.
abstract: OBJECTIVE
  Atrial fibrillation (AF) affects ∼2% of the total population. In order to prevent AF recurrences, many anti-arrhythmic drugs are currently available, but most of them are burdened by serious side effects and suboptimal efficacy. The aim of the present study was to test efficacy and safety of a combination of flecainide and metoprolol in preventing AF clinical recurrences.
  
  
  RESULTS
  This study is a monocentric, prospective, randomized, open-blinded trial on 173 patients with a recent episode of paroxysmal or persistent AF. Patients were randomized into group A (flecainide + metoprolol; n = 80), group B (flecainide only; n = 72), or group C (metoprolol only; n = 21). Main exclusion criteria were recent acute coronary syndrome, heart failure New York Heart Association class III-IV, left ventricular ejection fraction <0.40, atrioventricular conduction disorders, and severe bradycardia. Primary endpoint was symptomatic recurrence over 1-year follow-up. Secondary endpoint was quality of life (QoL) over 1-year follow-up, as assessed by the SF-36 and Atrial Fibrillation Severity Scale questionnaires. Combination therapy with flecainide and metoprolol significantly reduced recurrences at 1-year follow-up when compared with flecainide alone in the whole population (66.7 vs. 46.8%; P < 0.001) and in patients with persistent AF (71.1 vs. 43.6%; P = 0.025) while adding beta-blocker therapy to paroxysmal AF showed no benefit over IC anti-arrhythmic drug-only. Patients randomized to combination therapy experienced a significant improvement of QoL when compared with those assigned to a flecainide-only regimen irrespective of AF type.
  
  
  CONCLUSIONS
  Flecainide-metoprolol combination therapy improves effectiveness of rhythm control in persistent symptomatic AF and increases tolerability, with a concomitant reduction of side effects and a better compliance.
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Via Conca 71, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Via Conca 71, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Piangerelli
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Via Conca 71, Ancona, Italy.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ricciotti
authors.affiliation: Cardiology Department, 'Murri' Hospital, Fermo, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Gabrielli
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Via Conca 71, Ancona, Italy f.guerra@univpm.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Guerra
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005424:Flecainide / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D008790:Metoprolol; D005424:Flecainide
keywords: Anti-arrhythmic drugs; Atrial fibrillation; Beta-blockers; Flecainide; Rhythm control