Short-term antiarrhythmic drug treatment postcardioversion could be effective

By Piriya Mahendra

Short-term antiarrhythmic drug treatment after cardioversion is less effective than long-term treatment, but prevents most recurrences of atrial fibrillation (AF), a study in The Lancet shows.

Persistent AF or death occurred in 120 (46%) of 261 patients who received short-term treatment with flecainide compared with 103 (39%) of 263 patients who received long-term treatment with the drug.

The event-free survival rate in patients who received short-term compared with long-term treatment was 48.4% versus 56.4%.

In post-hoc landmark analysis of patients who had not reached the primary endpoint in the first month, long-term treatment was significantly superior to short-term treatment, at a hazard ratio of 0.31 (p=0.0001).

At the end of the study, short-term therapy achieved the equivalent of approximately 80% of the effect of long-term therapy, the authors say.

"Although antiarrhythmic short-term treatment is inferior to long-term treatment, it will be useful in selected patients. Short-term treatment should be considered for AF patients who are at increased risk for complications or adverse effects," commented lead author Paulus Kirchhof (University of Münster, Germany) in a press statement.

"We hope that the new results find their way into guidelines for the management of AF."

The Flecainide Short-Long (FLEC-SL) trial enrolled patients between May 2007 and March 2010 across 44 centers in Germany. All patients had persistent AF and were undergoing planned cardioversion.

After successful cardioversion, patients were randomly allocated to receive either no antiarrhythmic drug treatment (control; n=81), treatment with flecainide 200-300 mg per day for 4 weeks (short-term treatment), or flecainide at the same dosage for 6 months (long-term treatment).

Patients were monitored for the recurrence of AF for 6 months using daily telemetric electrocardiography.

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