CHAPTER 34 PILL-IN-THE-POCKET APPROACH FOR ATRIAL FIBRILLATION

Outpatient Treatment of Recent-onset Atrial Fibrillation with the “Pill-in-the-Pocket” Approach

Alboni P, Botto GL, Baldi N, et al. N Engl J Med. 2004;351(23):2384–2391

BACKGROUND

Recurrent episodes of paroxysmal atrial fibrillation are responsible for a large number of ED visits, many of them by otherwise healthy people who only have a few events each year. Radiofrequency ablation is only used in patients who have frequent arrhythmic episodes despite long-term oral prophylaxis. This excludes a category of patients with infrequent and typically well-tolerated episodes. Pharmacologic cardioversion mechanisms such as propafenone and flecainide have proven safe, effective, and timely in converting atrial fibrillation in the inpatient settings. However, no studies examined patient directed, at home therapy as an alternative to hospital admission.

OBJECTIVES

This study attempted to determine if a single dose of patient-administered antiarrhythmic such as propafenone or flecainide could be used to cardiovert a limited subset of patients to sinus rhythm in the outpatient setting.

METHODS

Prospective comparative therapeutic study in Italy between 2001 and 2003.

Participants

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