Original Article
Outpatient Treatment of Recent-Onset Atrial Fibrillation with the “Pill-in-the-Pocket” Approach
N Engl J Med 2004; 351:2384-2391December 2, 2004
- Abstract
Background
In-hospital administration of flecainide and propafenone in a single oral loading dose has been shown to be effective and superior to placebo in terminating atrial fibrillation. We evaluated the feasibility and the safety of self-administered oral loading of flecainide and propafenone in terminating atrial fibrillation of recent onset outside the hospital.
Methods
We administered either flecainide or propafenone orally to restore sinus rhythm in 268 patients with mild heart disease or none who came to the emergency room with atrial fibrillation of recent onset that was hemodynamically well tolerated. Of these patients, 58 (22 percent) were excluded from the study because of treatment failure or side effects. Out-of-hospital self-administration of flecainide or propafenone — the “pill-in-the-pocket” approach — after the onset of heart palpitations was evaluated in the remaining 210 patients (mean age [±SD], 59±11 years).
Results
During a mean follow-up of 15±5 months, 165 patients (79 percent) had a total of 618 episodes of arrhythmia; of those episodes, 569 (92 percent) were treated 36±93 minutes after the onset of symptoms. Treatment was successful in 534 episodes (94 percent); the time to resolution of symptoms was 113±84 minutes. Among the 165 patients with recurrences, the drug was effective during all the arrhythmic episodes in 139 patients (84 percent). Adverse effects were reported during one or more arrhythmic episodes by 12 patients (7 percent), including atrial flutter at a rapid ventricular rate in 1 patient and noncardiac side effects in 11 patients. The numbers of monthly visits to the emergency room and hospitalizations were significantly lower during follow-up than during the year before the target episode (P<0.001 for both comparisons).
Conclusions
In a selected, risk-stratified population of patients with recurrent atrial fibrillation, pill-in-the-pocket treatment is feasible and safe, with a high rate of compliance by patients, a low rate of adverse events, and a marked reduction in emergency room visits and hospital admissions.
Media in This Article
Figure 1
Enrollment and Treated and Untreated Episodes of Atrial Fibrillation.Table 1
Clinical Characteristics of 210 Patients Enrolled for Out-of-Hospital Treatment of Recurrent Atrial Fibrillation.Article Activity
- Article
In patients with recurrent atrial fibrillation, long-term oral prophylaxis with antiarrhythmic drugs has long been used to prevent recurrences. However, both the need for daily administration of antiarrhythmic agents and the risk of adverse effects are recognized as disadvantages of long-term prophylaxis.1-5 In addition, relapses are frequent. During the past few years, radiofrequency catheter ablation of pulmonary veins has been introduced into clinical practice.6 However, in all studies, the procedure has been used only in patients who have frequent arrhythmic episodes despite long-term oral prophylaxis.7 Some patients with recurrent atrial fibrillation may present with episodes that are not frequent and are well tolerated but that are long enough in duration that they require either emergency room intervention or hospitalization.
Oral prophylaxis or catheter ablation may not be the most appropriate first-line treatment for such patients. An alternative treatment is the “pill-in-the-pocket” approach, in which the patient takes a single oral dose of an antiarrhythmic drug at the time of the onset of palpitations. This type of treatment has already been investigated in studies carried out in hospitalized patients with atrial fibrillation of recent onset. The oral drugs that have been used to convert atrial fibrillation of recent onset to sinus rhythm are class IA, class IC, and class III antiarrhythmic agents.8-22 The class IC agents flecainide and propafenone have the advantage of acting rapidly, and their efficacy in converting atrial fibrillation of recent onset to sinus rhythm has been documented in several placebo-controlled trials.8,13,15,16,18,20,22,23 The two drugs had similar efficacy in the studies, and the success rates ranged from 58 to 95 percent.8-13,15-20,23 In all controlled studies, a low incidence of adverse effects has been reported.8-13,15-20,22,23 The most serious side effect appears to be a transient atrial flutter with a rapid ventricular rate owing to an atrioventricular conduction ratio of 1:1 (in about 1 percent of patients).
We conducted a study to assess the feasibility and safety of treatment with either flecainide or propafenone administered as a single oral dose outside the hospital to terminate atrial fibrillation of recent onset in patients without severe heart disease who have infrequent, well-tolerated arrhythmic episodes. The primary end points were the rate of success with this treatment and the rate of adverse events. The secondary end points were the rates of emergency room visits and hospital admissions as compared with those in the year preceding enrollment in the study.
Methods
Study Population
The inclusion criteria were an age of 18 to 75 years, emergency room intervention for an episode of electrocardiographically documented atrial fibrillation of recent onset (<48 hours earlier), a mean heart rate of more than 70 beats per minute, and a systolic pressure of 100 mm Hg or more. Additional criteria for inclusion in the study were a history of palpitations with an abrupt onset that were hemodynamically well tolerated (i.e., without symptoms such as dyspnea, presyncope, or syncope), at least 1 but fewer than 12 episodes of atrial fibrillation (excluding the target episode) in the previous year, and no cardiac symptoms apart from the episodes of arrhythmia.
Patients were excluded if they had one or more of the following findings: electrocardiographic evidence of ventricular pre-excitation or bundle-branch block (QRS interval, >120 msec), a previous episode of atrial fibrillation lasting seven days or more, ischemic heart disease, dilated or hypertrophic cardiomyopathy, a history of heart failure, severe valvular heart disease, chronic cor pulmonale, left ventricular dysfunction (ejection fraction, <50 percent), a long QT interval or the Brugada syndrome, the bradycardia–tachycardia syndrome (resting heart rate, ≤50 beats per minute, or repetitive sinoatrial blocks during waking hours), documentation of previous episodes of second- or third-degree atrioventricular block, previous thromboembolic episodes, acute disease, very severe chronic diseases (e.g., muscular dystrophies or systemic collagen diseases), renal or hepatic insufficiency, previous hypokalemia (potassium level, <3 mmol per liter), suspected or known pregnancy, a known intolerance of flecainide or current propafenone, or current prophylactic antiarrhythmic treatment.
We obtained a medical history for all patients and performed a physical examination, electrocardiography, routine biochemical laboratory tests (including an assay of thyroid hormones), and two-dimensional echocardiography. Other investigations, such as exercise stress testing, were performed when clinically indicated. Patients were recruited from September 1, 2001, to February 28, 2003; follow-up was terminated September 30, 2003.
The study was approved by the local ethics committee, and written informed consent was obtained from all participants. A committee monitored the progress of the study. At two of the study sites (Como and Taranto), all the patients requiring emergency room intervention for atrial fibrillation of recent onset were monitored in order to determine the percentage of patients who were considered candidates for out-of-hospital treatment.
In-Hospital Antiarrhythmic Treatment
The patients were treated either in the emergency room or in the cardiology ward. Each hospital used its own criteria for admission, which were the same during the study period as they were in the year preceding enrollment. The researchers at each center used the drug (either flecainide or propafenone) with which they were more familiar.
For conversion of atrial fibrillation to sinus rhythm, oral flecainide or propafenone was administered in a single dose according to the weight of the patient. The dose of flecainide was 300 mg if the patient weighed 70 kg or more and was 200 mg otherwise; the dose of propafenone was 600 mg if the patient weighed 70 kg or more and was 450 mg otherwise. After administration of the drug, heart rhythm was monitored for at least 8 hours, blood pressure was measured every 30 minutes with the use of a cuff, and a 12-lead electrocardiogram was recorded every hour. The treatment was considered successful if the interval between administration of the drug and conversion to sinus rhythm was six hours or less and there were no observable side effects, such as symptomatic hypotension (systolic blood pressure, ≤80 mm Hg), symptomatic bradycardia after restoration of sinus rhythm, dyspnea, presyncope, syncope, conversion to atrial flutter or atrial tachycardia, or episodes of sustained or unsustained ventricular tachycardia.
Out-of-Hospital Episodic Treatment
Patients were recruited for in-hospital treatment if all the inclusion criteria were fulfilled and no exclusion criteria were documented after the medical history had been obtained and physical examination and electrocardiographic studies performed. Patients were selected for out-of-hospital treatment from among those who were treated successfully in the hospital and were not excluded during subsequent examination.
Before discharge, all patients who had been treated successfully in the hospital were instructed to take the drug five minutes after any subsequent onset of palpitations. After the ingestion of the drug, a resting state (in a supine or sitting position) was recommended until the palpitations had stopped or at least four hours had passed. Patients were also given a form and asked to record the number of arrhythmic episodes they had; the exact times of onset of palpitations, drug ingestion, and termination of symptoms; and any adverse effects.
Patients were advised to contact the emergency room if their palpitations had not ceased six to eight hours after the ingestion of the drug, if they had symptoms that had not occurred during previous arrhythmic episodes (e.g., dyspnea, presyncope, or syncope), or if they felt a marked increase in heart rate after ingestion of the drug. Finally, patients were advised not to take more than one oral dose during a 24-hour period. After discharge, patients were seen in the outpatient clinic every four months.
Statistical Analysis
All the investigators had full access to the data and performed the data analysis. Data are expressed as means ±SD. Continuous variables were compared by using Student's t-test for independent samples. A two-tailed chi-square test was used to determine the statistical significance of associations in two-by-two tables. The efficacy of the oral drug was provided as a crude estimate. However, because calculation of drug efficacy may be biased if individual patients have multiple treated episodes, an adjusted estimate of efficacy was obtained by using the generalized estimating equation with an exchangeable correlation structure.24 This method controls for multiple responses from one patient by assuming a common correlation between any two responses. A P value of less than 0.05 by two-sided test was considered to indicate statistical significance.
Results
In-Hospital Treatment
A total of 268 consecutive patients with atrial fibrillation of recent onset received an in-hospital oral dose of flecainide (mean dose, 263±54 mg) or propafenone (mean dose, 555±81 mg). Of those patients, 138 were treated in the emergency room and 130 in the cardiology ward. Of the 268 patients who were treated, 58 were not given out-of-hospital treatment for the following reasons (Figure 1Figure 1
Enrollment and Treated and Untreated Episodes of Atrial Fibrillation.): exclusion criteria were identified during echocardiographic recording in 3 (1 percent), the drug was not effective in restoring sinus rhythm within six hours in 41 (15 percent), and the drug induced side effects in 14 (5 percent), including transient hypotension (4), transient atrial flutter (7), and slightly symptomatic bradycardia (3). Of the seven patients who had transient atrial flutter after drug administration, one had an atrioventricular conduction ratio of 1:1 and six had an atrioventricular conduction ratio of 2:1 or more. The mean heart rate was more than 150 beats per minute in one patient (230 beats per minute); none of the patients had syncope, presyncope, or hypotension or needed electrical cardioversion. The remaining 210 patients were discharged and given flecainide (74) or propafenone (136) for pill-in-the-pocket treatment of recurrent atrial fibrillation. In these patients, the mean duration of atrial fibrillation before in-hospital treatment was 280±368 minutes (median, 120), and the mean time to conversion to sinus rhythm was 135±79 minutes (median, 120).In Como and Taranto, where all patients with atrial fibrillation of recent onset who came to the emergency room were monitored during the recruiting period, the total number of patients was 541 and the number of patients who were candidates for out-of-hospital treatment was 65 (12 percent).
Clinical Characteristics
The clinical characteristics of the 210 patients who were discharged and given flecainide or propafenone are reported in Table 1Table 1
Clinical Characteristics of 210 Patients Enrolled for Out-of-Hospital Treatment of Recurrent Atrial Fibrillation.. A total of 118 patients had no signs of organic heart disease, and the remaining 92 (44 percent) had mild heart disease (hypertension in 76, valvular heart disease without ventricular hypertrophy or dilatation in 12, and other conditions in 4).Out-of-Hospital Treatment
The mean follow-up period was 15±5 months (range, 7 to 19) (Figure 1). Four patients (2 percent) were lost to follow-up. Of the remaining 206 patients, 41 (20 percent) did not have any arrhythmic recurrences during the follow-up period, and 165 reported a total of 618 episodes of palpitations with an abrupt onset, 569 (92 percent) of which were treated with either flecainide (in 64 patients) or propafenone (in 101 patients). As compared with the patients who had recurrences, those without recurrences were younger (P=0.008) and had had fewer emergency room interventions (P<0.001) and hospitalizations (P=0.01) during the previous year.
The mean time from the onset of symptoms to the ingestion of the drug was 36±93 minutes (median, 10). The drug was effective (i.e., palpitations were interrupted within six hours) in 534 of 569 arrhythmic episodes (94 percent; corrected efficacy, 93 percent; 95 percent confidence interval, 90 to 95). The mean time to the resolution of symptoms after the ingestion of the drug was 113±84 minutes (median, 98). Flecainide was effective in 239 of 254 episodes (94 percent), and propafenone in 295 of 315 (94 percent).
Sixteen arrhythmic episodes (3 percent) were interrupted after more than 6 hours (range, 390 to 890 minutes) without the patients' contacting the emergency room. Twenty-six episodes (5 percent) required emergency room intervention, 10 of which (2 percent) also required hospitalization. Of the total of 618 episodes of palpitations, 49 were not treated, either because the patient felt that the arrhythmic attack was mild or because the drug was unavailable, and 5 of these episodes (10 percent) required emergency room intervention. Thus, during the follow-up period, a total of 31 treated or untreated arrhythmic episodes (5 percent) resulted in emergency room visits, and 10 of these episodes required hospitalization. Of the 31 emergency room visits, 19 were due to episodes of atrial fibrillation that lasted for more than six hours, 1 to acceleration of the heart rate after drug ingestion, and 11 to anxiety. (Among the calls that were attributed to anxiety, seven involved a request for emergency room intervention even though the atrial fibrillation had lasted for less than six hours and was well tolerated and four involved a request for an electrocardiogram although palpitations had ceased.)
Among the 165 patients with recurrences, the drug was effective during all the arrhythmic episodes in 139 (84 percent). Of the 27 patients who had at least one episode that lasted for more than six hours after the ingestion of the drug, 9 (5 percent) did not request emergency room intervention, whereas 18 (11 percent) did. During the follow-up period, 31 patients took atrioventricular nodal blockers for treatment of hypertension (beta-blockers in 24 and verapamil in 7).
Comparison with the Year before Enrollment
Among the 210 patients enrolled, the mean number of symptomatic episodes per month for the group was 59.8 in the year before enrollment (excluding the target episode) and 54.5 during the follow-up period, not a significant difference. During follow-up, the number of calls for emergency room intervention was 4.9 per month, which was significantly lower than the number per month in the year before the target episode (45.6, P<0.001). The number of hospitalizations per month during the follow-up period was also significantly lower (1.6 vs. 15.0, P<0.001).
Adverse Effects
Adverse effects during one or more arrhythmic episodes were reported in 12 of the 165 patients who used the drug during follow-up (7 percent). One patient (0.6 percent) felt a marked acceleration of heart rate after ingestion of the drug and contacted the emergency room; the electrocardiogram showed atrial flutter, with an atrioventricular conduction ratio of 1:1 and a ventricular rate of 210 beats per minute. The remaining 11 patients reported noncardiac side effects such as nausea, asthenia, and vertigo.
Twenty-seven of the 210 patients (13 percent) dropped out of the study after a mean of 7±3 months: 13 (6 percent) because the drug was ineffective, 7 (3 percent) because of multiple episodes requiring antiarrhythmic prophylactic treatment, 2 (1 percent) because of adverse effects (atrial flutter at a rapid ventricular rate in 1 and nausea in 1), and 5 (2 percent) because of psychological problems or noncompliance.
Discussion
Several controlled studies carried out in hospitalized patients have shown that oral flecainide and propafenone, in the first three to eight hours after administration, have a similar efficacy and are more effective than placebo and other oral antiarrhythmic agents such as amiodarone and quinidine plus digoxin.8-13,15-20 Our study focused on out-of-hospital treatment for atrial fibrillation of recent onset. The main finding is that self-administration of a single oral loading dose of flecainide or propafenone is feasible and safe and appears to be effective.
During the in-hospital phase, treatment with flecainide or propafenone was successful in about 80 percent of patients. We chose resolution of palpitations within six hours after ingestion of the drug as the criterion of efficacy because after six hours, the rate of success of oral class IC agents is similar to that of placebo; moreover, a period of six hours is reasonable from the clinical point of view. The dose we used had previously been demonstrated to be the most suitable for oral treatment.8,16,18,22,25
After the exclusion of patients who had a conversion to sinus rhythm after more than six hours or adverse effects during in-hospital treatment, we found that oral flecainide and propafenone interrupted 94 percent of the out-of-hospital arrhythmic episodes, and in 84 percent of the patients, the treatment was effective for all the arrhythmic episodes, with a mean conversion time of about two hours. In the remaining patients, failure occurred during one or more episodes because the drug was ineffective or unavailable. However, despite efficacy, about 5 percent of the patients dropped out of the study because of multiple recurrences, side effects (especially nausea), or anxiety.
During out-of-hospital treatment, the incidence of adverse effects was low. Only one patient (0.6 percent) felt a marked acceleration of the heart rate after the ingestion of flecainide, and the electrocardiogram recorded in the emergency room showed atrial flutter with a rapid ventricular rate. This finding indicates that successful in-hospital treatment does not rule out an atrial flutter at a high rate during subsequent treatment out of the hospital.
The pill-in-the-pocket strategy markedly reduced emergency room visits and hospital admissions. The reduction in hospitalizations paralleled the reduction in emergency room visits. These data are of clinical significance because emergency room visits and hospital admissions often represent the most important concern for patients with recurrent atrial fibrillation. However, among the patients in our study who contacted the emergency room during the recruitment period, only a small group (12 percent) were candidates for out-of-hospital treatment. A not-unexpected finding was that the clinical course may deteriorate in some patients; this was the case in 7 of the 210 patients in the study (3 percent), who were switched from pill-in-the-pocket treatment to prophylactic antiarrhythmic therapy owing to the occurrence of more frequent arrhythmic episodes.
In evaluating the out-of-hospital efficacy of class IC drugs in recurrent atrial fibrillation, we did not perform a randomized comparison of these drugs with placebo because several in-hospital trials had already demonstrated the superiority of oral flecainide and propafenone over placebo during observation periods of four to eight hours. The purpose of our study was to investigate the feasibility and safety of the pill-in-the-pocket approach. During the follow-up period, arrhythmic episodes and concomitant drug treatment were assessed on the basis of the patients' symptoms. We cannot exclude the possibility that some episodes of palpitations were the result of arrhythmias other than atrial fibrillation. The use of patient-activated transmission of cardiac data by telephone in choosing the arrhythmic episodes to be treated would have enabled us to evaluate more precisely the efficacy of flecainide and propafenone in terminating recurrent episodes of atrial fibrillation. However, this approach would not have allowed us to investigate the safety of the pill-in-the-pocket strategy in the real world.
The pill-in-the-pocket approach appears to be feasible and safe, in view of the high rate of patient compliance and the very low incidence of adverse effects. Data from our study show that the pill-in-the-pocket strategy with flecainide and propafenone is effective for all the arrhythmic episodes in more than 80 percent of patients with recurrent atrial fibrillation, after selection of patients on the basis of clinical features and the results of in-hospital treatment. Out-of-hospital treatment minimizes the need for subsequent emergency room visits and hospitalization, which should reduce the costs associated with atrial fibrillation, albeit in a small group of patients who have this tachyarrhythmia. The safety of this approach without previous evaluation of in-hospital treatment remains to be investigated.
Supported by a grant from the Associazione Italiana di Aritmologia e Cardiostimolazione.
Source Information
From the Divisions of Cardiology, Ospedale Civile, Cento (P.A., L.G.); Ospedale S. Anna, Como (G.L.B., M.L.); Ospedale SS. Annunziata, Taranto (N.B., V.R.); Ospedale del Delta, Lagosanto (P.M.); Arcispedale Santa Maria Nuova, Reggio Emilia (M.C.); Ospedali Riuniti, Lavagna (A.S.); Ospedale Galmarini, Tradate (R.B.); and Ospedale Civile, Sampierdarena (G.G.) — all in Italy.
Address reprint requests to Dr. Alboni at the Division of Cardiology, Ospedale Civile, I-44042 Cento, Italy, or at p.alboni@ausl.fe.it.
Additional study investigators are listed in the Appendix.
Appendix
The members of the steering committee of the study (with their locations in Italy) were P. Alboni (Cento), N. Baldi (Taranto), G. Boriani (Bologna), G.L. Botto (Como), M. Brignole (Lavagna), A. Capucci (Piacenza), A. Del Rosso (Fucecchio), A. De Simone (Maddaloni), G. Inama (Crema), G. Marinoni (Pavia), C. Menozzi (Reggio Emilia), and A. Raviele (Mestre–Venezia). Participating centers and investigators included Ospedale Civile, Cento, L. Gianfranchi; Ospedale S. Anna, Como, M. Luzi; Ospedale SS. Annunziata, Taranto, V. Russo; Ospedale del Delta, Lagosanto, P. Marchi; Arcispedale Santa Maria Nuova, Reggio Emilia, M. Calzolari; Ospedali Riuniti, Lavagna, A. Solano; Ospedale Galmarini, Tradate, R. Baroffio; Ospedale Civile, Sampierdarena, G. Gaggioli; Ospedale Renzetti, Lanciano, D. Tullio; Policlinico S. Orsola, Bologna, G. Boriani; Ospedale Ceccarini, Riccione, N. Candiotti; Ospedale Ferrari, Casarano, A. Marzo; Ospedale S.C. di Gesù, Gallipoli, L. Stella; Ospedale Civile, Sassuolo, F. Melandri.
- References
References
1
Mannino MM ,Metha D ,Gomes JA . Current treatment options for paroxysmal supraventricular tachycardia. Am Heart J 1994;127:475-480
CrossRef | Web of Science | Medline2
Hohnloser SH ,Kuck KH ,Lilienthal J . Rhythm or rate control in atrial fibrillation -- Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomized trial. Lancet 2000;356:1789-1794
CrossRef | Web of Science | Medline3
Wyse DG ,Waldo AL ,DiMarco JP , et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-1833
Full Text | Web of Science | Medline4
Van Gelder IC ,Hagens VE ,Bosker HA , et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834-1840
Full Text | Web of Science | Medline5
Carlsson J ,Miketic S ,Windeler J , et al. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 2003;41:1690-1696
CrossRef | Web of Science | Medline6
Haissaguerre M ,Jais P ,Shah DC , et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-666
Full Text | Web of Science | Medline7
Jais P ,Shah DC ,Hocini M , et al. Radiofrequency ablation for atrial fibrillation. Eur Heart J 2003;5:Suppl:H34-H39
CrossRef | Web of Science8
Villani GQ ,Rosi A ,Piepoli M , et al. The efficacy of oral treatment with flecainide for paroxysmal atrial fibrillation: correlation with plasma concentration. G Ital Cardiol 1990;20:564-568
Medline9
Capucci A ,Lenzi T ,Boriani G , et al. Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension. Am J Cardiol 1992;70:69-72
CrossRef | Web of Science | Medline10
Botto GL ,Bonini W ,Broffoni T , et al. Regular ventricular rhythms before conversion of recent onset atrial fibrillation to sinus rhythm. Pacing Clin Electrophysiol 1994;17:2114-2117
CrossRef | Web of Science | Medline11
Capucci A ,Boriani G ,Botto GL , et al. Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide. Am J Cardiol 1994;74:503-505
CrossRef | Web of Science | Medline12
Capucci A ,Boriani G ,Rubino I ,Della Casa S ,Sanguinetti M ,Magnani B . A controlled study on oral propafenone versus digoxin plus quinidine in converting recent onset atrial fibrillation to sinus rhythm. Int J Cardiol 1994;43:305-313
CrossRef | Web of Science | Medline13
Boriani G ,Capucci A ,Lenzi T ,Sanguinetti M ,Magnani B . Propafenone for conversion of recent-onset atrial fibrillation: a controlled comparison between oral loading dose and intravenous administration. Chest 1995;108:355-358
CrossRef | Web of Science | Medline14
Halinen MO ,Huttunen M ,Paakkinen S ,Tarssanen L . Comparison of sotalol with digoxin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the Sotalol-Digoxin-Quinidine Trial). Am J Cardiol 1995;76:495-498
CrossRef | Web of Science | Medline15
Botto GL ,Bonini W ,Broffoni T , et al. Conversion of recent onset atrial fibrillation with single loading oral dose of propafenone: is in-hospital admission absolutely necessary? Pacing Clin Electrophysiol 1996;19:1939-1943
CrossRef | Web of Science | Medline16
Azpitarte J ,Alvarez M ,Baun O , et al. Value of single oral loading dose of propafenone in converting recent-onset atrial fibrillation: results of a randomized, double-blind, controlled study. Eur Heart J 1997;18:1649-1654
Web of Science | Medline17
Boriani G ,Biffi M ,Capucci A , et al. Oral propafenone to convert recent-onset atrial fibrillation in patients with and without underlying heart disease: a randomized, controlled trial. Ann Intern Med 1997;126:621-625
Web of Science | Medline18
Botto GL ,Capucci A ,Bonini W , et al. Conversion of recent onset atrial fibrillation to sinus rhythm using a single loading oral dose of propafenone: comparison of two regimens. Int J Cardiol 1997;58:55-61
CrossRef | Web of Science | Medline19
Botto GL ,Bonini W ,Broffoni T , et al. Randomized, crossover, controlled comparison of oral loading versus intravenous infusion of propafenone in recent-onset atrial fibrillation. Pacing Clin Electrophysiol 1998;21:2480-2484
CrossRef | Web of Science | Medline20
Blanc JJ ,Voinov C . Maarek M. Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. Am J Cardiol 1999;84:1029-1032
CrossRef | Web of Science | Medline21
Kishikawa T ,Maruyoma T ,Kaji Y , et al. Effects of oral repetitive loading of disopyramide on acute-onset atrial fibrillation with concurrent monitoring of serum drug concentration. Int J Cardiol 1999;68:57-62
CrossRef | Web of Science | Medline22
Khan IA . Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. J Am Coll Cardiol 2001;37:542-547
CrossRef | Web of Science | Medline23
Capucci A ,Villani GQ ,Piepoli MF . Reproducible efficacy of loading oral propafenone in restoring sinus rhythm in patients with paroxysmal atrial fibrillation. Am J Cardiol 2003;92:1345-1347
CrossRef | Web of Science | Medline24
Zeger SL ,Liang KY ,Albert PS . Models for longitudinal data: a generalized estimating equation approach. Biometrics 1988;44:1049-1060[Erratum, Biometrics 1989;45:347.]
CrossRef | Web of Science | Medline25
Capucci A ,Boriani G ,Marchesini B , et al. Minimal effective concentration values of propafenone and 5-hydroxy-propafenone in acute and chronic therapy. Cardiovasc Drugs Ther 1990;4:281-287
CrossRef | Web of Science | Medline
- Citing Articles (93)
Citing Articles
1
S. Gelsomino, M. La Meir, F. Luca, R. Lorusso, E. Crudeli, L. Vasquez, G. F. Gensini, J. Maessen. (2012) Treatment of lone atrial fibrillation: a look at the past, a view of the present and a glance at the future. European Journal of Cardio-Thoracic Surgery
CrossRef2
R. Pisters, R. Nieuwlaat, M. H. Prins, J.-Y. Le Heuzey, A. P. Maggioni, A. J. Camm, H. J. G. M. Crijns, . (2012) Clinical correlates of immediate success and outcome at 1-year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey. Europace
CrossRef3
Alexander Burashnikov, Charles Antzelevitch. (2011) Novel pharmacological targets for the rhythm control management of atrial fibrillation. Pharmacology & Therapeutics 132:3, 300-313
CrossRef4
Ruby F. Rivera, Paul Chambers, Scott R. Ceresnak. (2011) Evaluation of Children With Palpitations. Clinical Pediatric Emergency Medicine 12:4, 278-288
CrossRef5
A. John Camm, Christian F. Camm, Irina Savelieva. (2011) Medical treatment of atrial fibrillation. Journal of Cardiovascular Medicine1
CrossRef6
Alexander Burashnikov, Charles Antzelevitch. (2011) Ranolazine versus amiodarone for prevention of postoperative atrial fibrillation. Future Cardiology 7:6, 733-737
CrossRef7
Antonio Vincenti, Matteo Rota, Monica Spinelli, Mariella Corciulo, Sergio De Ceglia, Giovanni Rovaris, Laura Antolini, Simonetta Genovesi. (2011) A noninvasive index of atrial remodeling in patients with paroxysmal and persistent atrial fibrillation: a pilot study. Journal of Electrocardiology
CrossRef8
H. Almroth, T. Andersson, E. Fengsrud, L. Friberg, P. Linde, M. Rosenqvist, A. Englund. (2011) The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events. Journal of Internal Medicine 270:3, 281-290
CrossRef9
Shinsuke Miyazaki, Ashok J. Shah, Daniel Scherr, Michel Haïssaguerre. (2011) Atrial fibrillation: Pathophysiology and current therapy. Annals of Medicine 43:6, 425-436
CrossRef10
Charles Antzelevitch, Alexander Burashnikov, Serge Sicouri, Luiz Belardinelli. (2011) Electrophysiologic basis for the antiarrhythmic actions of ranolazine. Heart Rhythm 8:8, 1281-1290
CrossRef11
GABOR Z. DURAY, CHRISTIAN TORP-PEDERSEN, STUART J. CONNOLLY, STEFAN H. HOHNLOSER. (2011) Effects of Dronedarone on Clinical Outcomes in Patients with Lone Atrial Fibrillation: Pooled Post Hoc Analysis from the ATHENA/EURIDIS/ADONIS Studies. Journal of Cardiovascular Electrophysiology 22:7, 770-776
CrossRef12
Alessandro Marinelli, Alessandro Capucci. (2011) Antiarrhythmic drugs for atrial fibrillation. Expert Opinion on Pharmacotherapy 12:8, 1201-1215
CrossRef13
2011. Appendix. , 386-418.
CrossRef14
2011. Active Supraventricular Arrhythmias. , 93-180.
CrossRef15
E. Aliot, A. Capucci, H. J. Crijns, A. Goette, J. Tamargo. (2011) Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation. Europace 13:2, 161-173
CrossRef16
Walid Saliba, Oussama M. Wazni. (2011) Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials. Clinical Cardiology 34:1, 12-22
CrossRef17
Fabiana Lucà, Mark La Meir, Carmelo Massimiliano Rao, Orlando Parise, Ludovico Vasquez, Rocco Carella, Roberto Lorusso, Benedetto Daniela, Jos Maessen, Gian Franco Gensini, Sandro Gelsomino. (2011) Pharmacological Management of Atrial Fibrillation: One, None, One Hundred Thousand. Cardiology Research and Practice 2011, 1-10
CrossRef18
Razali Omar, Wee Siong Teo, David Foo, Chee Kok Han, Ahmad Nizar Jamaluddin, Lip Ping Low, Tiong Kiam Ong. (2011) Atrial Fibrillation in Singapore and Malaysia: Current Trends and Future Prospects. Journal of Arrhythmia 27:3, 171-185
CrossRef19
Saumy Sharma, Trieu Ho, Bharat Kantharia. 2010. Cardiac Antiarrhythmic Agents. .
CrossRef20
Ursula Ravens. (2010) Antiarrhythmic therapy in atrial fibrillation. Pharmacology & Therapeutics 128:1, 129-145
CrossRef21
, , , A. J. Camm, P. Kirchhof, G. Y. H. Lip, U. Schotten, I. Savelieva, S. Ernst, I. C. Van Gelder, N. Al-Attar, G. Hindricks, B. Prendergast, H. Heidbuchel, O. Alfieri, A. Angelini, D. Atar, P. Colonna, R. De Caterina, J. De Sutter, A. Goette, B. Gorenek, M. Heldal, S. H. Hohloser, P. Kolh, J.-Y. Le Heuzey, P. Ponikowski, F. H. Rutten, , A. Vahanian, A. Auricchio, J. Bax, C. Ceconi, V. Dean, G. Filippatos, C. Funck-Brentano, R. Hobbs, P. Kearney, T. McDonagh, B. A. Popescu, Z. Reiner, U. Sechtem, P. A. Sirnes, M. Tendera, P. E. Vardas, P. Widimsky, , P. E. Vardas, V. Agladze, E. Aliot, T. Balabanski, C. Blomstrom-Lundqvist, A. Capucci, H. Crijns, B. Dahlof, T. Folliguet, M. Glikson, M. Goethals, D. C. Gulba, S. Y. Ho, R. J. M. Klautz, S. Kose, J. McMurray, P. Perrone Filardi, P. Raatikainen, M. J. Salvador, M. J. Schalij, A. Shpektor, J. Sousa, J. Stepinska, H. Uuetoa, J. L. Zamorano, I. Zupan. (2010) Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 12:10, 1360-1420
CrossRef22
, , , A. J. Camm, P. Kirchhof, G. Y. H. Lip, U. Schotten, I. Savelieva, S. Ernst, I. C. Van Gelder, N. Al-Attar, G. Hindricks, B. Prendergast, H. Heidbuchel, O. Alfieri, A. Angelini, D. Atar, P. Colonna, R. De Caterina, J. De Sutter, A. Goette, B. Gorenek, M. Heldal, S. H. Hohloser, P. Kolh, J.-Y. Le Heuzey, P. Ponikowski, F. H. Rutten, , A. Vahanian, A. Auricchio, J. Bax, C. Ceconi, V. Dean, G. Filippatos, C. Funck-Brentano, R. Hobbs, P. Kearney, T. McDonagh, B. A. Popescu, Z. Reiner, U. Sechtem, P. A. Sirnes, M. Tendera, P. E. Vardas, P. Widimsky, , P. E. Vardas, V. Agladze, E. Aliot, T. Balabanski, C. Blomstrom-Lundqvist, A. Capucci, H. Crijns, B. Dahlof, T. Folliguet, M. Glikson, M. Goethals, D. C. Gulba, S. Y. Ho, R. J. M. Klautz, S. Kose, J. McMurray, P. Perrone Filardi, P. Raatikainen, M. J. Salvador, M. J. Schalij, A. Shpektor, J. Sousa, J. Stepinska, H. Uuetoa, J. L. Zamorano, I. Zupan. (2010) Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Journal 31:19, 2369-2429
CrossRef23
C. J. Taylor, J. Hodgkinson, F. D. R Hobbs. (2010) Rhythm control agents and adverse events in patients with atrial fibrillation. International Journal of Clinical Practice 64:8, 1069-1075
CrossRef24
Edward C Li, John S Esterly, Shaunte Pohl, Shane D Scott, Brian F McBride. (2010) Drug-Induced QT-Interval Prolongation: Considerations for Clinicians. Pharmacotherapy 30:7, 684-701
CrossRef25
Fikret Er, Orhan Aslan, Evren Caglayan, Natig Gassanov, Amir M. Nia, Erland Erdmann, Stephan Rosenkranz. (2010) Flecainide for cardioversion in patients at elevated cardiovascular risk and persistent atrial fibrillation: a prospective observational study. Clinical Research in Cardiology 99:6, 369-373
CrossRef26
Giuseppe Boriani, Mauro Biffi, Igor Diemberger, Giulia Domenichini, Alessandro Marziali, Cristian Martignani. (2010) Atrial fibrillation: Adverse effects of “pill-in-the-pocket” treatment and propafenone–carvedilol interaction. International Journal of Cardiology 140:2, 242-243
CrossRef27
Jens Litmathe, Anna Maria Litmathe. (2010) Simethicone—another “pill in the pocket” in paroxysmal atrial fibrillation?. International Journal of Cardiology 140:3, e55
CrossRef28
Alexander Burashnikov, Charles Antzelevitch. (2010) New developments in atrial antiarrhythmic drug therapy. Nature Reviews Cardiology 7:3, 139-148
CrossRef29
JCS Joint Working Group. (2010) Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2008). Circulation Journal 74:11, 2479-2500
CrossRef30
Marcus L. Koller, Burghard Schumacher. (2010) Medikamentöse Therapie von Herzrhythmusstörungen. Medizinische Klinik 105:1, 26-40
CrossRef31
Saumy Sharma, Trieu Ho, Bharat Kantharia. 2010. .
CrossRef32
C. Pappone, A. Radinovic, F. Manguso, G. Vicedomini, S. Sala, F. M. Sacco, G. Ciconte, M. Saviano, M. Ferrari, E. Sommariva, S. Sacchi, C. Ciaccio, E. M. Kallergis, V. Santinelli. (2009) New-onset atrial fibrillation as first clinical manifestation of latent Brugada syndrome: prevalence and clinical significance. European Heart Journal 30:24, 2985-2992
CrossRef33
P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, C. W. Israel, K.-H. Kuck, G. Y.H. Lip, S. Nattel, R. L. Page, U. Ravens, U. Schotten, G. Steinbeck, P. Vardas, A. Waldo, K. Wegscheider, S. Willems, G. Breithardt. (2009) Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF'. European Heart Journal 30:24, 2969-2980
CrossRef34
S. Boveda, E. Marijon, A. Deplagne, P. Hausman, M. El Bayomi, S. Combes, N. Combes, A. Bortone, J.-P. Albenque. (2009) Contrôle du rythme sinusal – Cardioversion. Annales de Cardiologie et d'Angéiologie 58, S38-S41
CrossRef35
Rakesh Gopinathannair, Renee M. Sullivan, Brian Olshansky. (2009) Update on medical management of atrial fibrillation in the modern era. Heart Rhythm 6:8, S17-S22
CrossRef36
JAMES A. REIFFEL. (2009) Cardioversion for Atrial Fibrillation: Treatment Options and Advances. Pacing and Clinical Electrophysiology 32:8, 1073-1084
CrossRef37
P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, C. W. Israel, K.-H. Kuck, G. Y.H. Lip, S. Nattel, R. L. Page, U. Ravens, U. Schotten, G. Steinbeck, P. Vardas, A. Waldo, K. Wegscheider, S. Willems, G. Breithardt. (2009) Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'. Europace 11:7, 860-885
CrossRef38
Mark A. Crandall, David J. Bradley, Douglas L. Packer, Samuel J. Asirvatham. (2009) Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies. Mayo Clinic Proceedings 84:7, 643-662
CrossRef39
M. A. Crandall, D. J. Bradley, D. L. Packer, S. J. Asirvatham. (2009) Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies. Mayo Clinic Proceedings 84:7, 643-662
CrossRef40
B.A. Hoffmann, I. Wilke, I. Drewitz, D. Steven, T. Rostock, S. Willems. (2009) Rationelle Therapie von Vorhofflimmern in der Intensivmedizin. Intensivmedizin und Notfallmedizin 46:4, 193-199
CrossRef41
(2009) Japanese Journal of Electrocardiology 29:1, 58-58
CrossRef42
T. Meinertz, S. Willems. (2008) Die Behandlung von Vorhofflimmern im Alltag. Der Internist 49:12, 1437-1445
CrossRef43
P. Peñafiel Verdú, A. García Alberola, M. Valdés Chávarri. (2008) Manejo de la fibrilación/flutter auricular de reciente comienzo. Medicine - Programa de Formación Médica Continuada Acreditado 10:23, 1540-1546
CrossRef44
R. Gopinathannair, B. Olshansky. (2008) Ibutilide revisited: stronger and safer than ever. Europace 11:1, 9-10
CrossRef45
Imke Drewitz, Thomas Rostock, Boris Hoffmann, Daniel Steven, Helge Servatius, Thomas Meinertz, Stephan Willems, . (2008) Aktuelle Therapiestrategien bei Vorhofflimmern. Medizinische Klinik 103:11, 788-800
CrossRef46
H. Volkmann, L. Richter, C. Bergmann. (2008) Pharmakologische Therapie bei Vorhofflimmern – Was leisten moderne Antiarrhythmika wirklich?. Clinical Research in Cardiology Supplements 3:1, 101-106
CrossRef47
B. Lüderitz. (2008) Rationale und rationelle Behandlung des Vorhofflimmerns. Clinical Research in Cardiology Supplements 3:1, 95-100
CrossRef48
Alessandro Riccardi, Roberto Lerza. (2008) Controversies in the “pill in the pocket” approach to atrial fibrillation. Internal and Emergency Medicine 3:2, 187-189
CrossRef49
T. Lewalter, J. Tebbenjohanns, T. Wichter, M. Antz, C. Geller, K.-H. Seidl, D. Gulba, F.R. Röhrig, S. Willems. (2008) Kommentar zu „ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary“. Der Kardiologe 2:3, 181-205
CrossRef50
Michael J. Mazzini, Kevin M. Monahan. (2008) Pharmacotherapy for atrial arrhythmias: Present and future. Heart Rhythm 5:6, S26-S31
CrossRef51
Spencer J. Melby, Andreas Zierer, Jordon G. Lubahn, Marci S. Bailey, James L. Cox, Richard B. Schuessler, Ralph J. Damiano. (2008) Normal Quality of Life After the Cox-Maze Procedure for Atrial Fibrillation. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 3:3, 142-146
CrossRef52
Simone Musco, Emily L. Conway, Peter R. Kowey. (2008) Drug Therapy for Atrial Fibrillation. Medical Clinics of North America 92:1, 121-141
CrossRef53
Susan S. Kim, Bradley P. Knight. (2008) Electrical and Pharmacologic Cardioversion for Atrial Fibrillation. Medical Clinics of North America 92:1, 101-120
CrossRef54
Benzy J. Padanilam, Eric N. Prystowsky. (2008) Atrial Fibrillation: Goals of Therapy and Management Strategies to Achieve the Goals. Medical Clinics of North America 92:1, 217-235
CrossRef55
Atul Khasnis, Ranjan K. Thakur. (2008) Atrial Fibrillation: A Historical Perspective. Medical Clinics of North America 92:1, 1-15
CrossRef56
Ian G. Stiell, Catherine M. Clement, Cheryl Symington, Jeffrey J. Perry, Christian Vaillancourt, George A. Wells. (2007) Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or Flutter. Academic Emergency Medicine 14:12, 1158-1164
CrossRef57
Y. Blaauw, H. J. G. M. Crijns. (2007) Atrial fibrillation: insights from clinical trials and novel treatment options. Journal of Internal Medicine 262:6, 593-614
CrossRef58
Carmelo Lafuente-Lafuente, Stephane Mouly, Miguel Angel Longas-Tejero, Jean-François Bergmann, Carmelo Lafuente-Lafuente. 2007. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. .
CrossRef59
Deepak Bhakta, John M Miller. (2007) Pharmacologic targets for atrial fibrillation. Expert Opinion on Therapeutic Targets 11:9, 1161-1178
CrossRef60
P. Kirchhof, G. Breithardt. (2007) Therapie von Vorhofflimmern. Der Internist 48:8, 819-831
CrossRef61
B. Lüderitz. (2007) Vorhofflimmern – alte und neue Prinzipien der pharmakologischen Rhythmusskontrolle. Clinical Research in Cardiology Supplements 2:4, IV58-IV63
CrossRef62
Mark C Haigney. (2007) Ablation should not be first-line therapy for the treatment of atrial fibrillation. Expert Review of Cardiovascular Therapy 5:4, 673-679
CrossRef63
Esther H. Chen, Judd E. Hollander. (2007) When Do Patients Need Admission to a Telemetry Bed?. The Journal of Emergency Medicine 33:1, 53-60
CrossRef64
Paulus Kirchhof, Günter Breithardt. (2007) New concepts for old drugs to maintain sinus rhythm in patients with atrial fibrillation. Heart Rhythm 4:6, 790-793
CrossRef65
Samuel Lévy. (2007) Do we need pharmacological therapy for atrial fibrillation in the ablation era?. Journal of Interventional Cardiac Electrophysiology 17:3, 189-194
CrossRef66
Massimo Santini, Renato P. Ricci. (2007) The worldwide social burden of atrial fibrillation: What should be done and where do we go?. Journal of Interventional Cardiac Electrophysiology 17:3, 183-188
CrossRef67
Hirotsugu Atarashi, Satoshi Ogawa, Hiroshi Inoue, Chikuma Hamada, The Flecainide Atrial Fibrillation. (2007) Dose-Response Effect of Flecainide in Patients With Symptomatic Paroxysmal Atrial Fibrillation and/or Flutter Monitored With Trans-Telephonic Electrocardiography. Circulation Journal 71:3, 294-300
CrossRef68
(2006) ACC/AHA/ESC: Guías de Práctica Clínica 2006 para el manejo de pacientes con fibrilación auricular. Versión resumida. Revista Española de Cardiología 59:12, 1329.e1-1329.e64
CrossRef69
Kosuke Doki, Masato Homma, Keisuke Kuga, Kazutomi Kusano, Shigeyuki Watanabe, Iwao Yamaguchi, Yukinao Kohda. (2006) Effect of CYP2D6 genotype on flecainide pharmacokinetics in Japanese patients with supraventricular tachyarrhythmia. European Journal of Clinical Pharmacology 62:11, 919-926
CrossRef70
M. G. Hennersdorf, B. E. Strauer. (2006) Vorhofflimmern. Der Internist 47:10, 990-1000
CrossRef71
D. Steven, B. Lutomsky, T. Rostock, S. Willems. (2006) Moderne Pharmakotherapie bei supraventrikulären und ventrikulären Herzrhythmusstörungen. Der Internist 47:10, 1013-1023
CrossRef72
Todd Rudo, Peter Kowey. (2006) Atrial fibrillation: Choosing an antiarrhythmic drug. Current Cardiology Reports 8:5, 370-376
CrossRef73
Ahmad Hersi, D. George Wyse. (2006) Medical management of atrial fibrillation. Current Cardiology Reports 8:5, 323-329
CrossRef74
Valentin Fuster, Lars E. Rydén, David S. Cannom, Harry J. Crijns, Anne B. Curtis, Kenneth A. Ellenbogen, Jonathan L. Halperin, Jean-Yves Le Heuzey, G. Neal Kay, James E. Lowe, S. Bertil Olsson, Eric N. Prystowsky, Juan Luis Tamargo, Samuel Wann. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology 48:4, e149-e246
CrossRef75
Valentin Fuster, Lars E. Rydén, David S. Cannom, Harry J. Crijns, Anne B. Curtis, Kenneth A. Ellenbogen, Jonathan L. Halperin, Jean-Yves Le Heuzey, G. Neal Kay, James E. Lowe, S. Bertil Olsson, Eric N. Prystowsky, Juan Luis Tamargo, Samuel Wann. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary. Journal of the American College of Cardiology 48:4, 854-906
CrossRef76
H. Hein, N. Panhuyzen-Goedkoop, D. Corrado, E. Hoffmann, A. Biffi, P. Delise, C. Blomstrom-Lundqvist, L. Vanhees, P. IvarHoff, U. Dorwarth, A. Pelliccia, . (2006) Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers. European Journal of Cardiovascular Prevention & Rehabilitation 13:4, 475-484
CrossRef77
Ahmad Hersi, L. Brent Mitchell, D. George Wyse. (2006) Atrial fibrillation: Challenges and opportunities. Canadian Journal of Cardiology 22, 21C-26C
CrossRef78
Mark E. Anderson. (2006) Too Little, Too Late: Chasing Atrial Fibrillation with Sodium Channel Antagonists. Journal of Cardiovascular Electrophysiology 17:6, 655-656
CrossRef79
M. Linhart, T. Lewalter. (2006) Elektrische und pharmakologische Frühkardioversion von Vorhofflimmern. Herzschrittmachertherapie & Elektrophysiologie 17:2, 81-88
CrossRef80
Luis H. Haro, Erik P. Hess, Wyatt W. Decker. (2006) Arrhythmias in the Office. Medical Clinics of North America 90:3, 417-438
CrossRef81
T. Lewalter, G. Nickenig. (2006) Pharmakotherapie der supraventrikulären Rhythmusstörungen. Der Internist 47:1, 80-88
CrossRef82
HIROTSUGU ATARASHI. (2006) Nihon Naika Gakkai Zasshi 95:2, 228-233
CrossRef83
Ignacio Fernández Lozano, José L. Merino Llorens. (2006) Temas de actualidad 2005: electrofisiología y arritmias. Revista Española de Cardiología 59, 20-30
CrossRef84
Marino Leonardi, Joe Bissett. (2005) Prevention of atrial fibrillation. Current Opinion in Internal Medicine 4:6, 571-577
CrossRef85
Richard L. Page, Dan M. Roden. (2005) Drug therapy for atrial fibrillation: where do we go from here?. Nature Reviews Drug Discovery 4:11, 899-910
CrossRef86
Gemma Pelargonio, Eric N Prystowsky. (2005) Rate versus rhythm control in the management of patients with atrial fibrillation. Nature Clinical Practice Cardiovascular Medicine 2:10, 514-521
CrossRef87
Subhashini A. Gowda, Arti Shah, Jonathan S. Steinberg. (2005) Cardioversion of Atrial Fibrillation. Progress in Cardiovascular Diseases 48:2, 88-107
CrossRef88
Brian Olshansky. (2005) Rate versus rhythm control strategies for AF. Current Treatment Options in Cardiovascular Medicine 7:5, 371-381
CrossRef89
(2005) The “Pill-in-the-Pocket” Approach to Atrial Fibrillation. New England Journal of Medicine 352:11, 1150-1151
Full Text90
Iouri Bachmakov, Sabine Rekersbrink, Ute Hofmann, Michel Eichelbaum, Martin F. Fromm. (2005) Characterisation of (R/S)-propafenone and its metabolites as substrates and inhibitors of P-glycoprotein. Naunyn-Schmiedeberg's Archives of Pharmacology 371:3, 195-201
CrossRef91
E. Does. (2005) Zelfmedicatie bij aanvallen van onlangs ontstane atriumfibrillatie. Medisch-Farmaceutische Mededelingen 43:3, 74-74
CrossRef92
D George Wyse. (2005) Can recent-onset atrial fibrillation be safely and successfully treated with self-administered antiarrhythmic drugs?. Nature Clinical Practice Cardiovascular Medicine 2:3, 132-133
CrossRef93
Page, Richard L., . (2004) Newly Diagnosed Atrial Fibrillation. New England Journal of Medicine 351:23, 2408-2416
Full Text
- Letters
