Treatment of recent onset atrial fibrillation with intravenous sotalol and/or flecainide

Aim: The purpose of our study (conducted between August 1995 and September 1996) was to evaluate prospectively the efficacy of intravenous administration (in 10 min) of sotalol, flecainide or the combination of these drugs to restore sinus rhythm in patients (without cardiac/pulmonary failure) who came to the First Heart Aid of our hospital with atrial fibrillation lasting less than 24 h. Methods and Results: Patients in whom the rhythm was not converted to sinus rhythm by intravenous sotalol within 60 min, we started to give flecainide intravenously (2 mg/kg), In patients on oral beta blockade we started flecainide intravenously (2 mg/kg) over 10 min. Of the 92 patients who fulfilled the entry criteria 51 were on oral beta blocking agents for angina, hypertension or to prevent atrial fibrillation. Of these patients, 43 (84%) converted to sinus rhythm with intravenous flecainide, The 41 patients not on a beta blocking agents were treated with 40 mg sotalol intravenously which led to sinus rhythm in 22 patients (54%). Sixteen of the 19 remaining patients (84%) converted to sinus rhythm after subsequent administration of flecainide. Therefore of the whole group of 70 patients treated with flecainide, 59 (84%) were successfully converted. Out of the 92 patients, 11 patients were not converted to sinus rhythm. Six were treated successfully by electrical cardioversion. The others were treated with oral flecainide/sotalol or digoxine with persistence of atrial fibrillation. Conclusion: The findings of this study suggest that intravenous sotalol is a good choice for termination of recent onset atrial fibrillation in a patient with a good left ventricular function. If not successful then flecainide had to be added. (C) 1998 Elsevier Science B.V, All rights reserved.