“Pill-in-the-Pocket” Approach

  • Paolo Alboni
Conference paper


In the clinical setting, some patients with recurrent atrial fibrillation (AF) present with episodes that are not frequent (< 1 per month) and are hemodynamically well-tolerated, but which are long enough to require emergency room (ER) intervention or hospitalization. These patients need treatment, but long-term oral prophylaxis or catheter ablation may not be the most appropriate first-line therapy. Rather, in this group of patients the “pill-in-the-pocket” approach, consisting of a single-dose oral ingestion of an anti-arrhythmic agent at the time and place of palpitation onset, may offer a more appropriate treatment strategy. The pill-in-the-pocket has already been investigated in studies carried out in hospital, in patients with recent-onset AF. The oral drugs that have been used to convert recent-onset AF to sinus rhythm are class IA, class IC, and class III anti-arrhythmic agents [1, 2, 3, 4, 5, 6, 7]. The class IC agents flecainide and propafenone have the advantage of being conveniently administered in a single oral dose that acts rapidly and causes minimal side effects [1, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16]. The efficacy of a single oral loading dose of flecainide and propafenone in converting recent-onset AF to sinus rhythm has been documented by several placebo-controlled trials [1, 6, 8, 9, 11, 13, 16]. The two drugs showed similar efficacy, and their success rate varied from 58 to 95% [1, 6, 8, 9, 10, 11, 12, 13], depending on the duration of AF and the observation period after drug administration.


Atrial Fibrillation Sinus Rhythm Atrial Flutter Recurrent Atrial Fibrillation Onset Atrial Fibrillation 
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Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Paolo Alboni
    • 1
  1. 1.Division of Cardiology and Arrhythmologic CenterOspedale CivileCento (FE)Italy

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