Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation
Open accessAbstract
Objectives We tested the hypothesis that the response to flecainide infusion can identify patients with atrial fibrillation (AF) in whom the hybrid pharmacologic and ablation therapy reduces the recurrences of AF.Background Infusion of class IC anti-arrhythmic drugs may promote transformation of AF into atrial flutter. Catheter ablation of atrial flutter has been demonstrated to be highly effective in preventing recurrences of atrial flutter.Methods Seventy-one consecutive patients with paroxysmal or chronic AF, in whom flecainide infusion (2 mg/kg body weight, intravenously) determined the transformation of AF into common atrial flutter (positive response), were randomized to receive one of the following treatments: oral pharmacologic treatment with flecainide (group A, n = 23); the hybrid treatment (catheter ablation of the inferior vena cava-tricuspid annulus isthmus, plus oral flecainide) (group B, n = 24); or catheter ablation of the isthmus only (group C, n = 24). Thirty-seven patients with a negative response to flecainide, who chose to be submitted to the hybrid treatment, were selected as the control group (group D).Results During a mean follow-up period of 24 +/- 7.2 months, the recurrences of AF and atrial flutter in group B (42%) were significantly lower than those in group A (78%, p < 0.001), group C (92%, p < 0.001) and group D (92%, p < 0.001).Conclusions The creation of a complete bi-directional conduction block at the inferior vena cava-tricuspid annulus isthmus, plus flecainide administration, reduces the recurrences of both AF and atrial flutter in patients with class IC atrial flutter. Moreover, the early response to flecainide is safe and reliable in identifying patients who may benefit from this therapy.
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Combining cavotricuspid isthmus ablation and antiarrhythmic drugs may lead to improved rhythm control without the need for left atrial ablation in patients who develop 'drug-induced atrial flutter' on therapy with flecainide, propafenone, or amiodarone.
“Combining cavotricuspid isthmus ablation and antiarrhythmic drugs may lead to improved rhythm control without the need for left atrial ablation in patients who develop 'drug-induced atrial flutter' on therapy with flecainide, propafenone, or amiodarone, [834][835][836]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [836]
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- Authors
- Stabile, G., De Simone, A., Turco, P., La Rocca, V., Nocerino, P., Astarita, C., Maresca, F., De Matteis, C., Di Napoli, T., Stabile, E., & Vitale, D. F.
- Affiliations
- Casa di Cura San Michele (IT)
- University of Naples Federico II (IT)
- Fondazione Salvatore Maugeri (IT)
- Corresponding author
- Stabile, Giuseppe
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2001-05
- Volume
- 37
- Issue
- 6
- Pages
- 1639-1644
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2001512592
- Cited by
- 46
- References
- 18
- Citations by year
- 2023: 1 · 2020: 1 · 2019: 1 · 2017: 1 · 2016: 3 · 2014: 2 · 2013: 1 · 2012: 2
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Zenodo (CERN European Organization for Nuclear Research) (other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, flecainide, atrial flutter, catheter ablation, class Ic antiarrhythmic drugs, atrial flutter recurrence, atrial fibrillation recurrence, bidirectional block
- MeSH terms
- Administration, Oral, Aged, Analysis of Variance, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Chronic Disease, Combined Modality Therapy, Electrocardiography, Female, Flecainide, Follow-Up Studies, Humans, Infusions, Intravenous, Male, Middle Aged, Predictive Value of Tests, Recurrence, Proportional Hazards Models, Treatment Outcome, Catheter Ablation, Disease-Free Survival, Patient Selection
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