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Outpatient Treatment of Recent-Onset Atrial Fibrillation with the “Pill-in-the-Pocket” Approach
Open accessAbstract
BACKGROUND: In-hospital administration of flecainide and propafenone in a single oral loading dose has been shown to be effective and superior to placebo in terminating atrial fibrillation. We evaluated the feasibility and the safety of self-administered oral loading of flecainide and propafenone in terminating atrial fibrillation of recent onset outside the hospital. METHODS: We administered either flecainide or propafenone orally to restore sinus rhythm in 268 patients with mild heart disease or none who came to the emergency room with atrial fibrillation of recent onset that was hemodynamically well tolerated. Of these patients, 58 (22 percent) were excluded from the study because of treatment failure or side effects. Out-of-hospital self-administration of flecainide or propafenone--the "pill-in-the-pocket" approach--after the onset of heart palpitations was evaluated in the remaining 210 patients (mean age [+/-SD], 59+/-11 years). RESULTS: During a mean follow-up of 15+/-5 months, 165 patients (79 percent) had a total of 618 episodes of arrhythmia; of those episodes, 569 (92 percent) were treated 36+/-93 minutes after the onset of symptoms. Treatment was successful in 534 episodes (94 percent); the time to resolution of symptoms was 113+/-84 minutes. Among the 165 patients with recurrences, the drug was effective during all the arrhythmic episodes in 139 patients (84 percent). Adverse effects were reported during one or more arrhythmic episodes by 12 patients (7 percent), including atrial flutter at a rapid ventricular rate in 1 patient and noncardiac side effects in 11 patients. The numbers of monthly visits to the emergency room and hospitalizations were significantly lower during follow-up than during the year before the target episode (P<0.001 for both comparisons). CONCLUSIONS: In a selected, risk-stratified population of patients with recurrent atrial fibrillation, pill-in-the-pocket treatment is feasible and safe, with a high rate of compliance by patients, a low rate of adverse events, and a marked reduction in emergency room visits and hospital admissions.
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“An alternative to emergency department treatment for patients with infrequent but disabling AF is the”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Alboni et al., 2004
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Items 101–200 of 478
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“Single-dose oral propafenone and flecainide are safe and effective in a “pill in the pocket” strategy for patients with relatively infrequent symptomatic AF paroxysms.(49) Although class IC agents are the most efficacious anti-AF NCBs, they are not only ineffective in atrial flutter (AFL) but may also promote conversi…”
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Acute Management of Atrial Fibrillation
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Pulmonary Delivery of Antiarrhythmic Drugs for Rapid Conversion of New-Onset Atrial Fibrillation
Verrier, R. L., & Belardinelli, L. (2020) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000000804 · Cited by 15
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Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation
Ma, C., Wu, S., Liu, S., & Han, Y. (2024) · 老年心脏病学杂志：英文版 · doi:10.26599/1671-5411.2024.03.009 · Cited by 16
Martı́n, A., Lozano, I. F., Puig, B. C.-V., Tercedor, L., del Arco, C., Ynsaurriaga, F. A., Méndez, C. S., & Girbau, L. M. (2012) · Emergencias · Cited by 14
Management of atrial fibrillation-0
Kakar, P., Boos, C. J., & Lip, G. Y. H. (2011) · PubMed Central · doi:10.6084/m9.figshare.18958 · Cited by 14
A Case of Sudden Cardiac Death due to Pilsicainide-Induced Torsades de Pointes
Nakatani, S., Taniike, M., Makino, N., Egami, Y., Shutta, R., Tanouchi, J., & Nishino, M. (2014) · Korean Circulation Journal · doi:10.4070/kcj.2014.44.2.122 · Cited by 13
Pluymaekers, N. A. H. A., Dudink, E. A. M. P., Weijs, B., Vernooy, K., Hartgerink, D., Jacobs, J., Erküner, Ö., Marcks, N., van Cauteren, Y. J. M., Dinh, T., et al. (2021) · Netherlands Heart Journal · doi:10.1007/s12471-020-01528-5 · Cited by 12
SEA 2024 Standards for Global Control of Vascular Risk
Mostaza, J. M., Pintó, X., Armario, P., Masana, L., Real, J. T., Valdivielso, P., Arrobas-Velilla, T., Baeza‐Trinidad, R., Calmarza, P., Cebollada, J., et al. (2024) · Clínica e Investigación en Arteriosclerosis (English Edition) · doi:10.1016/j.artere.2024.06.001 · Cited by 11
Lau, D. H., Kalman, J. M., & Sanders, P. (2014) · Clinical Therapeutics · doi:10.1016/j.clinthera.2014.08.002 · Cited by 12
Atrial Fibrillation: A Historical Perspective
Khasnis, A. A., & Thakur, R. K. (2008) · Cardiology Clinics · doi:10.1016/j.ccl.2008.09.013 · Cited by 12
Atrial Fibrillation in Athletes
Goudis, C. A., Ntalas, I. V., & Ketikoglou, D. G. (2014) · Cardiology in Review · doi:10.1097/crd.0000000000000049 · Cited by 13
“In some athletes with paroxysmal atrial fibrillation, class I antiarrhythmic agents can be used only for acute reconversion therapy (pill-in-the pocket approach).(87) Even though these drugs may prevent atrial fibrillation recurrences, atrial fibrillation can be converted to atrial flutter.”
BackgroundNew concepts for old drugs to maintain sinus rhythm in patients with atrial fibrillation
Kirchhof, P. F., & BREITHARDT, G. E. (2007) · Heart Rhythm · doi:10.1016/j.hrthm.2007.01.023 · Cited by 12
Er, F., Aslan, O., Caglayan, E., Gassanov, N., Nia, A. M., Erdmann, E., & Rosenkranz, S. (2010) · Clinical Research in Cardiology · doi:10.1007/s00392-010-0129-7 · Cited by 12
“In lowrisk populations, a safe conversion rate under oral flecainide of up to 92% has been reported [ 5 ].”
BackgroundIs delayed cardioversion the better approach in recent-onset atrial fibrillation? No
Capucci, A., & Compagnucci, P. (2019) · Internal and Emergency Medicine · doi:10.1007/s11739-019-02224-y · Cited by 12
Raviele, A. (2006) · Springer eBooks · doi:10.1007/88-470-0371-7 · Cited by 12
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“flecainide or propafenone does not predict adverse events during out-of-hospital self-administration [67].”
BackgroundTatangelo, M., Rebecchi, M., Sgueglia, M., Colella, A., Crescenzi, C., Panattoni, G., Ciampi, P., Lanza, O., Canali, E., & Calò, L. (2023) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd10060255 · Cited by 13
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Antiarrhythmic Drug Therapy for Atrial Fibrillation
Sardar, M. R., Saeed, W., & Kowey, P. R. (2014) · Cardiology Clinics · doi:10.1016/j.ccl.2014.07.012 · Cited by 11
Cardioversion of Atrial Fibrillation
Gowda, S. A., Shah, A. N., & Steinberg, J. S. (2005) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2005.06.006 · Cited by 11
Novel anti-arrhythmic agents for the treatment of atrial fibrillation
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Moderne Pharmakotherapie bei supraventrikulären und ventrikulären Herzrhythmusstörungen
Steven, D., Lutomsky, B. A., Rostock, T., & Willems, S. (2006) · Der Internist · doi:10.1007/s00108-006-1709-5 · Cited by 11
Practical guidance for management of atrial fibrillation in sports cardiology
Palermi, A., Molinari, L. V., Ricci, F., Gallina, S., & Renda, G. (2025) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2025.102995 · Cited by 12
Waldo, A. L. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.08.006 · Cited by 10
Bronis, K., Metaxa, S., Koulouris, S. N., & Manolis, A. S. (2012) · Hospital chronicles/Hospital Chronicles · doi:10.2015/hc.v7i3.461 · Cited by 10
Marum, A. A., Silva, B. A., Bortolotto, A. L., Silva, A. C., de Antonio, V. Z., Belardinelli, L., & Verrier, R. L. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.09.029 · Cited by 10
Metadata
- Authors
- Alboni, P., Botto, G. L., Baldi, N., Luzi, M., Russo, V., Gianfranchi, L., Marchi, P., Calzolari, M., Solano, A., Baroffio, R., & Gaggioli, G.
- Affiliations
- Ospedale Sant'Anna (IT)
- Ospedale SS. Annunziata (IT)
- Santa Maria Nuova Hospital (IT)
- ORCID
- Botto, Giovanni L.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-12-02
- Volume
- 351
- Issue
- 23
- Pages
- 2384-2391
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2026137049
- Cited by
- 479
- References
- 28
- Citations by year
- 2026: 15 · 2025: 11 · 2024: 18 · 2023: 19 · 2022: 16 · 2021: 21 · 2020: 21 · 2019: 10 · 2018: 18 · 2017: 22 · 2016: 25 · 2015: 20 · 2014: 31 · 2013: 23 · 2012: 20
- FWCI
- 16.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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, propafenone, oral loading dose, outpatient care, self-administration, sinus rhythm restoration, emergency department visits, hospitalization reduction, adverse drug reactions, atrial flutter
- MeSH terms
- Administration, Oral, Ambulatory Care, Anti-Arrhythmia Agents, Atrial Fibrillation, Feasibility Studies, Female, Flecainide, Follow-Up Studies, Heart Failure, Humans, Male, Middle Aged, Propafenone, Prospective Studies, Self Administration, Stroke Volume
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