Combined use of 1C and III agents for highly symptomatic, refractory atrial fibrillation
Despite advances in non-pharmacologic therapy for atrial fibrillation (AF), some patients remain highly refractory.
We report our experience with the unique combined use of 1C and III agents in patients with highly refractory paroxysmal atrial fibrillation.
Materials and methods
Six patients with symptomatic AF (three persistent) were selected after failing multiple antiarrhythmic medications and radiofrequency ablation. They were started on flecainide or propafenone and sotalol or dofetilide during three days of inpatient monitoring. No patient had coronary artery disease. All patients had loop recorder follow-up and ECG recordings during clinic visits for a mean follow-up of 9 ± 11 months.
After therapy, all patients had complete, sustained control of their symptoms with no evidence of AF or proarrhythmia on monitoring. One patient had recurrence of AF after stopping sotalol and was started back on the drug with complete control.
Combined therapy with a 1C and III agent may be an effective alternative for the treatment of selective, highly refractory AF. Careful patient selection and hospitalization for initiation is necessary to minimize potential proarrhythmic effects. As this is a short-term therapy, further study is needed to assess the extent of efficacy in a larger number of patients.
KeywordsAtrial fibrillation Drug therapy Class 1C Class III Flecainide Propafenone Sotalol
Unable to display preview. Download preview PDF.
- 2.Fuster, V., Ryden, L. E., Asinger, R. W., Cannom, D. S., Crijns, H. J. & Frye, R. L., et al. (2001). American College of Cardioloy/American Heart Association/European Society of Cardiology Board. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the North American Society of Pacing and Electrophysiology. Journal of the American College of Cardiology, 38, 1231–1266.PubMedCrossRefGoogle Scholar
- 7.Wazni, O. M., Marrouche, N. F., Martin, D. O., Verma, A., Bhargava, M., & Saliba, W. (2002). Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. Journal of the American Medical Association, 293, 2634–2640.CrossRefGoogle Scholar