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Flecainide acetate is classified as a class IC antiarrhythmic medication according to the Vaughan-Williams classification, primarily used to manage both ventricular and supraventricular tachycardia. It is commonly employed for pharmacological cardioversion of atrial fibrillation (AF) and is frequently used in the "pill-in-the-pocket" approach for on-demand rhythm control. Despite its efficacy, flecainide is associated with significant adverse effects, including cardiac arrest, dysrhythmias, and heart failure.
View Article and Find Full Text PDFFlecainide toxicity with pill-in-pocket approach from accidental overdose: a case report.
Eur Heart J Case Rep
October 2024
Division of Electrophysiology, Department of Cardiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA.
Background: The Pill-in-the-Pocket (PiP) approach may be used in highly selected patients to achieve acute pharmacological cardioversion into sinus rhythm. Flecainide toxicity is rarely reported, especially with patients who take flecainide as PiP, and only limited evidence exists in its management. We present a case of accidental flecainide overdose for a patient who is on PiP and the acute management strategy.
View Article and Find Full Text PDFNovel stroke prevention strategies following catheter ablation for atrial fibrillation.
Rev Esp Cardiol (Engl Ed)
August 2024
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. Electronic address:
Stroke prevention following successful catheter ablation of atrial fibrillation remains a controversial topic. Oral anticoagulation is associated with a significant reduction in stroke risk in the general atrial fibrillation population but may be associated with an increased risk of major bleeding, and the benefit: risk ratio must be considered. Improvement in successful catheter ablation and widespread use of cardiac monitoring devices may allow for novel anticoagulation strategies in a subset of patients with atrial fibrillation, which may optimize stroke prevention while minimizing bleeding risk.
View Article and Find Full Text PDFReal-world utilization of the pill-in-the-pocket method for terminating episodes of atrial fibrillation: data from the multinational Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) survey.
Europace
June 2023
St George's University Hospitals, Blackshaw Road, Tooting London SW17 0QT, UK.
Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Episodes may stop spontaneously (paroxysmal AF); may terminate only via intervention (persistent AF); or may persist indefinitely (permanent AF) (see European and American guidelines, referenced below, for more precise definitions). Recently, there has been renewed interest in an approach to terminate AF acutely referred to as 'pill-in-the-pocket' (PITP).
View Article and Find Full Text PDF"Pill-in-Pocket" anticoagulation for stroke prevention in atrial fibrillation.
J Cardiovasc Electrophysiol
October 2023
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Article Synopsis
- Uninterrupted anticoagulation for atrial fibrillation (AF) has been a standard practice since early research, aimed at preventing strokes regardless of how long AF lasts.
- However, this approach carries risks and may not be suitable for everyone with a history of AF.
- The REACT-AF trial is being introduced to investigate a more targeted method of anticoagulation, known as "pill in the pocket" approach, which could be more beneficial for certain patients.
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