Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .
Efficacy of flecainide for the reversion of acute onset atrial fibrillation.
The efficacy and safety of intravenous flecainide to convert recent-onset atrial fibrillation ( AF ) ( present for greater than or equal to 30 minutes and less than or equal to 72 hours and a ventricular response greater than or equal to 120 beats/min ) was investigated . A total of 102 patients without severe heart or circulatory failure were r and omized to receive either intravenous flecainide ( 2 mg/kg , maximum dose 150 mg ; 51 patients ) or placebo ( 51 patients ) in a double-blind trial . Digoxin ( 500 micrograms intravenously ) was administered to all patients who had not previously been receiving digoxin .  The  electrocardiogram  was monitored continuously during the study . In 29 ( 57 % ) patients stable sinus rhythm was restored within 1 hour after flecainide and in only 7 ( 14 % ) given placebo ( chi square 18.9 ; p = 0.000013 ; odds ratio 8.3 ; 95 % confidence interval 2.9 - 24.8 ) . Reversion to sinus rhythm within 1 hour after starting the trial medication was considered a pretrial end point and likely to be due to a drug effect . At the end of the 6-hour monitoring period , 34 patients ( 67 % ) in the flecainide group were in sinus rhythm whereas only 18 ( 35 % ) in the placebo group had reverted ( chi square 8.83 , p = 0.003 ; odds ratio 3.67 ; 95 % confidence interval 1.5 - 9.1 ) . Significant hypotension , although short lived , was more common in the flecainide group . One patient given flecainide developed torsades de pointes and was successfully electrically cardioverted . Flecainide is useful for the management of recent-onset AF both for control of the ventricular response and conversion to sinus rhythm . ( ABSTRACT TRUNCATED AT 250 WORDS
Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .