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CLINICAL STUDY: ELECTROPHYSIOLOGY

Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation

Giuseppe Stabile, MD^*, Antonio De Simone, MD^*, Pietro Turco, MD^*, Vincenzo La Rocca, MD^*, Pasquale Nocerino, MD^*, Costantino Astarita, MD, Francesco Maresca, MD, Carmine De Matteis, MD, Tommaso Di Napoli, MD, Eugenio Stabile, MD^|| and Dino Franco Vitale, MD^¶

^* Laboratorio di Elettrofisiologia, Casa di Cura "San Michele," Maddaloni (CE), Italy
Ospedale Civile di Sorrento, Sorrento (NA), Italy
Ospedale Civile di Arienzo, Arienzo (CE), Italy
Ospedale Civile di Polla, Polla (SA), Italy
^|| Università "Federico II" di Napoli, Napoli, Italy
^¶ Fondazione S. Maugeri I.R.C.C.S., Centro Medico di Telese, Telese (BN), Italy

Manuscript received August 9, 2000; revised manuscript received November 10, 2000, accepted January 24, 2001.

Reprint requests and correspondence: Dr. Giuseppe Stabile, Laboratorio di Elettrofisiologia, Casa di Cura San Michele, Via Appia 178, 81024 Maddaloni (CE), Italy
gmrstabile{at}tin.it

OBJECTIVES

We tested the hypothesis that the response to flecainide infusion can identify patients with atrial fibrillation (AF) in whom the hybrid pharmacologic and ablation therapy reduces the recurrences of AF.

BACKGROUND

Infusion of class IC anti-arrhythmic drugs may promote transformation of AF into atrial flutter. Catheter ablation of atrial flutter has been demonstrated to be highly effective in preventing recurrences of atrial flutter.

METHODS

Seventy-one consecutive patients with paroxysmal or chronic AF, in whom flecainide infusion (2 mg/kg body weight, intravenously) determined the transformation of AF into common atrial flutter (positive response), were randomized to receive one of the following treatments: oral pharmacologic treatment with flecainide (group A, n = 23); the hybrid treatment (catheter ablation of the inferior vena cava-tricuspid annulus isthmus, plus oral flecainide) (group B, n = 24); or catheter ablation of the isthmus only (group C, n = 24). Thirty-seven patients with a negative response to flecainide, who chose to be submitted to the hybrid treatment, were selected as the control group (group D).

RESULTS

During a mean follow-up period of 24 ± 7.2 months, the recurrences of AF and atrial flutter in group B (42%) were significantly lower than those in group A (78%, p < 0.001), group C (92%, p < 0.001) and group D (92%, p < 0.001).

CONCLUSIONS

The creation of a complete bi-directional conduction block at the inferior vena cava-tricuspid annulus isthmus, plus flecainide administration, reduces the recurrences of both AF and atrial flutter in patients with class IC atrial flutter. Moreover, the early response to flecainide is safe and reliable in identifying patients who may benefit from this therapy.

Abbreviations and Acronyms   AF = atrial fibrillation   ECG = electrocardiographic

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