Department of Internal Medicine III, Heart Center of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Clin Res Cardiol. 2010 Jun;99(6):369-73. doi: 10.1007/s00392-010-0129-7. Epub 2010 Feb 24.
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.
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.
The effectiveness, safety and influencing factors of flecainide for cardioversion in high-risk patients were prospectively assessed.
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.
When monitored properly, flecainide is safe and useful for cardioversion in patients at elevated cardiovascular risk.
氟卡尼被用作无结构性心脏病和心房颤动（AF）的患者进行药物电复律的口袋药物治疗。在有结构性心脏病和心血管风险升高的患者中，氟卡尼被认为是有害的。因此，缺乏关于心血管风险升高的患者单次剂量氟卡尼进行电复律的安全性和有效性的数据。
106 例近期发生 AF 且已知有结构性心脏病和/或升高的 PROCAM 评分的患者连续接受口服氟卡尼 300mg 进行电复律。
前瞻性评估氟卡尼在高危患者中电复律的有效性、安全性和影响因素。
在 106 例患者中的 43 例（40.6%）中，氟卡尼在 192.4 +/- 10.7 分钟内恢复窦性节律。在成功电复律的患者中，PROCAM 评分（41.5 +/- 0.56）与未成功电复律的患者（45.7 +/- 0.74）相比显著降低（P < 0.001）。ACE 抑制剂联合治疗与氟卡尼转复率显著降低相关（HR 2.3，95%CI，1.12-4.26，P < 0.01）。在 58 例氟卡尼电复律无效的患者中，进行了电复律，其中 47 例成功。任何患者均未发生危及生命的心律失常。最常见的副作用是窦性心动过缓和电复律后即刻出现短暂性窦性停搏（2-4s）。
在适当监测下，氟卡尼在心血管风险升高的患者中用于电复律是安全且有效的。
