Some patients with paroxysmal atrial fibrillation should carry flecainide or propafenone to self treat

doi:10.1136/bmj.39143.720602.BE

BMJ 2007;334:637 (24 March), doi:10.1136/bmj.39143.720602.BE

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Some patients with paroxysmal atrial fibrillation should carry flecainide or propafenone to self treat

A John Camm, British Heart Foundation professor of clinical cardiology, Irina Savelieva, senior research fellow

St George's, University of London, London SW17 0RE

Correspondence to: A J Camm, Division of Cardiac and Vascular Sciences, St George's, University of London, London SW17 0REjcamm@sgul.ac.uk

The first 150 words of the full text of this article appear below.

The clinical problem

Atrial fibrillation affects up to 1.5% of the population inthe United Kingdom,¹ about 200 000 of whom have recurrent episodes.Although such episodes often resolve spontaneously and within48 hours,² patients may be distressed by symptoms of palpitations,dizziness, fatigue, or chest pain. Such attacks generally respondto antiarrhythmic agents (such as a single intravenous doseof propafenone or flecainide),³ which are usually administeredunder monitoring in hospital.

Here we propose that patients could self treat with oral propafenoneor flecainide, using a "pill in the pocket" approach (therebynot needing to go to hospital), as suggested in recent national(National Institute for Health and Clinical Excellence) andinternational guidelines.⁴ ⁵ For details of our methods, pleasesee the box on bmj.com.

• Currently, patients without severe heartdisease who have infrequent paroxysmal atrial fibrillation requirehospital intervention for symptomatic episodes

• For selectedpatients, self treatment strategy is feasible, . . . [Full text of this article]