Showing papers by "Isabelle C. Van Gelder published in 1989"
TL;DR: In this paper, the efficacy and safety of flecainide were studied in the maintenance of sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter.
Abstract: The efficacy and safety of flecainide were studied in the maintenance of sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Eighty-one patients were randomized to flecainide treatment or no treatment. Baseline characteristics of both groups were comparable. Compared to previous studies, patients could be classified as difficult-to-treat patients. Multiple regression analysis showed New York Heart Association class I for exercise tolerance (p = 0.0004) and flecainide treatment (p = 0.01) to be the main factors increasing the arrhythmia-free episode. However, Mantel-Cox lifetable analysis did not reveal significant differences between arrhythmia-free survival curves of both treatment groups. In the flecainide-treated group, 9% of patients experienced side effects, mostly related to negative dromotropic effects. The incidence of ventricular proarrhythmia in this group of patients was low. Thus, flecainide may be effective in postponing arrhythmia recurrence, even in difficult-to-treat patients. Caution should be excercised in treating patients with underlying conduction disturbances, sick sinus syndrome or characteristics favoring development of ventricular proarrhythmia.
184 citations
TL;DR: Compared with quinidine, flecainide is less effective in the chemical cardioversion of chronic AF or atrial flutter to sinus rhythm and another difference might stem from the energy required for successful direct current electrical cardioversion in patients using fle cainide.
Abstract: Little is known about the effects of antiarrhythmic drugs on the atrial defibrillation threshold in humans. An early study with quinidine 1 showed a significant reduction in number of shocks and a decreased energy requirement to restore sinus rhythm in patients with chronic atrial fibrillation (AF). Quinidine was administered as a loading dose of 1,200 mg in 24 hours before direct current electrical cardioversion. In contrast, Sodermark et al 2 could not show any difference in the atrial defibrillation threshold between patients with chronic AF or atrial flutter treated with quinidine (600 to 800 mg twice daily during 2.5 days) and patients not so treated before direct current electrical cardioversion. Flecainide, a class Ic antiarrhythmic drug, is being used more and more for the treatment of supraventricular tachycardias. Compared with quinidine, flecainide is less effective in the chemical cardioversion of chronic AF or atrial flutter to sinus rhythm. 3 Another difference might stem from the energy required for successful direct current electrical cardioversion in patients using flecainide. Because of the absence of data about the effects of flecainide on the atrial defibrillation threshold, we compared the energy required in patients undergoing direct current electrical cardioversion for chronic AF or atrial flutter with or without intravenously administered flecainide.
61 citations