Low-dose flecainide infusion followed by oral pilsicainide is highly effective and safe for paroxysmal atrial fibrillation.

Purpose: The aim of this study was to evaluate the efficacy and safety of intravenous infusion of low-dose flecainide (50 mg) followed by oral pilsicainide (50 mg t.i.d.)in patients with paroxysmal atrial fibrillation (AF).

Methods: Thirty-one patients with symptomatic and hemodynamically stable AF lasting less than 48 h from its onset were enrolled. Firstly, intravenous flecainide was given, and if AF was maintained 1 h after the start of flecainide, oral pilsicainide was started.

Results: Sinus rhythm was restored in 14 patients by flecainide alone (45%), and 24 h later, AF was disappeared in additional 14 patients (45%), resulting in the overall conversion rate of 90%. No side effects were observed.

Conclusions: The combined therapy of i.v. low-dose flecainide followed by oral pilsicainide might be a promising strategy for the outpatient treatment of paroxysmal atrial fibrillation.