Abstract
Background
Despite advances in non-pharmacologic therapy for atrial fibrillation (AF), some patients remain highly refractory.
Objective
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.
Results
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.
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fenrich, A. L. Jr., Perry, J. C., & Friedman, R. A. (1995) Flecainide and amioarone: combined therapy for refractory tachyarrythmia in infancy. Journal of the American College of Cardiology, 25, 1195–1198.
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.
Gossinger, H. D., Siostrzonek, P., & Mosslacher, H. (1990) Combined sotalol and flecainide given at low dosage in patients with the Wolff–Parkinson–White syndrome. International Journal of Cardiology, 26, 380–382.
James, M. A., Papouchado, P., & Jones, J. V. (1989). Combined antiarrhythmic therapy with class 1 and class 3 drugs. Postgraduate Medical Journal, 65, 519–524.
Kirchhof, P., Engelen, M., Franz, M. R., Ribbing, M., Wasmer, K., & Breithardt, G., et al. (2005). Electrophysiological effects of flecainide and sotalol in the human atrium during persistent atrial fibrillation. Basic Research in Cardiology, 100, 112–121.
Price, J. F., Kertesz, N. J., Snyder, C. S., Friedman, R. A., & Fenrich, A. L. (2002). Flecainide and sotalol: a new combination therapy for refractory supraventricular tachycardia in children <1 year of age. Journal of the American College of Cardiology, 39, 517–520.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Narayan, G., Akhtar, M. & Sra, J. Combined use of 1C and III agents for highly symptomatic, refractory atrial fibrillation. J Interv Card Electrophysiol 15, 175–178 (2006). https://doi.org/10.1007/s10840-006-9002-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-006-9002-z