Objective-To investigate whether an oral loading dose of flecainide is as safe and eVective as intravenous flecainide for the cardioversion of acute atrial fibrillation. Design-Prospective, randomised, double blind, double placebo study. Setting-Cardiac care unit of a large district general hospital in the UK. Patients and methods-79 patients presenting with symptomatic acute atrial fibrillation: patients were given either intravenous flecainide (n = 39) or a solution of oral flecainide (n = 40), with appropriate placebos. All patients were heparinised during the study. Primary outcome measures-Safety; mean time to cardioversion; proportion of patients restored to sinus rhythm at two hours and eight hours after treatment. Analysis was by intention to treat. Results-There were no diVerences in baseline characteristics between the oral and intravenous groups. Both forms of flecainide were well tolerated, with no adverse clinical events during the study. The mean time to cardioversion was 110 minutes in the oral group and 52 minutes in the intravenous group (p = 0.002). Two hours after treatment, 27 of the 40 patients in the oral group (68%) and 25 of the 39 in the intravenous group (64%) had reverted to sinus rhythm (p = 0.74). Eight hours after treatment, 30 patients in the oral group (75%) and 28 in the intravenous group (72%) had reverted to sinus rhythm (p = 0.76). Conclusions-Intravenous flecainide restored sinus rhythm more rapidly than oral flecainide, but at two hours and eight hours after treatment there was no diVerence in the proportion of patients cardioverted by the two approaches. These results suggest a role for oral loading doses of flecainide in the treatment of acute or symptomatic paroxysmal atrial fibrillation. (Heart 2000;84:37-40) Keywords: atrial fibrillation; flecainide Atrial fibrillation is the most common cardiac arrhythmia, with a prevalence of between 2% and 4% in the general population over 60 years old, and an increasing incidence with age.
General practitioners in one health district were surveyed by postal questionnaire (including 15 sample electrocardiogram tracings) to assess their usage and competence in interpretation of the electrocardiogram. A response rate of 60% was achieved, of whom 40% said they used the electrocardiogram at least monthly and 43% used it 'always' or 'usually' in patients with suspected myocardial infarction at home. Overall competence in recognizing a variety of abnormalities was felt to be good. Recent qualification, the possession of a higher qualification (MRCP/MRCGP) and frequency of usage were associated with better performance. Even so, unequivocal acute myocardial infarction was misdiagnosed by 20% of respondents. These findings have implications for the provision of electrocardiographic services in primary care and the management of patients in the home with suspected myocardial infarction, particularly with the advent of thrombolytic therapy.
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