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Atrial flutter can be terminated by a class III antiarrhythmic drug but not by a class IC drug
Abstract
In atrial flutter, chemical conversion with class I drugs is often unsuccessful, whereas class III drugs seem more promising. The different electrophysiological effects of these drugs may explain this discrepancy. To date, only experimental data show the differential effects of these drugs on conversion rate and atrial flutter cycle length. This study evaluates the effects of the class IC antiarrhythmic drug flecainide, and of dofetilide, a new class III drug, on conversion rate and flutter cycle length in patients with atrial flutter. Flecainide (11 patients) was given as an intravenous bolus of 2 mg.kg-1 in 10 min and dofetilide (10 patients) as a maximum intravenous bolus of 8 micrograms.kg-1 in 15 min. Baseline characteristics were comparable between both groups. Only one patient treated with flecainide converted to sinus rhythm. This patient showed the largest flutter cycle length increase (280 to 420 ms). By contrast, seven of the 10 patients treated with dofetilide converted to sinus rhythm. Patients treated with flecainide showed a significantly larger increase in atrial flutter cycle length at the end of the infusion compared to the dofetilide-treated patients (from 226 +/- 28 to 317 +/- 52 ms vs from 221 +/- 26 to 239 +/- 39 ms, respectively). In conclusion, dofetilide is more effective than flecainide in the conversion of atrial flutter to sinus rhythm, despite the fact that flecainide produced a more prolonged flutter cycle length. Thus, action potential prolongation in the absence of conduction slowing seems more effective in terminating human atrial flutter than depression of the excitability.
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“Dofetilide and ibutilide, pure class III AADs, are very effective for interrupting AFL in intravenous administration, while Class Ia and Ic drugs have little or no effect.138 -142,149”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [138]
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Metadata
- Authors
- CRIJNS, H. J. G. M., VAN GELDER, I. C., KINGMA, J. H., DUNSELMAN, P. H. J. M., GOSSELINK, A. T. M., & LIE, K. I.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- CRIJNS, H. J. G. M.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-10
- Volume
- 15
- Issue
- 10
- Pages
- 1403-1408
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W1763503342
- Cited by
- 76
- References
- 0
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 1 · 2016: 4 · 2015: 5 · 2012: 2
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial flutter, chemical cardioversion, class III antiarrhythmic agents, class Ic antiarrhythmic drugs, flecainide, dofetilide, conversion to sinus rhythm, action potential prolongation
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Flutter, Double-Blind Method, Echocardiography, Electrocardiography, Female, Flecainide, Heart Conduction System, Humans, Infusions, Intravenous, Male, Middle Aged, Phenethylamines, Sulfonamides
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