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

doi:10.1136/bmj.39143.720602.BE

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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 clinical problem

Atrial fibrillation affects up to 1.5% of the population in the United Kingdom,1 about 200 000 of whom have recurrent episodes. Although such episodes often resolve spontaneously and within 48 hours,2 patients may be distressed by symptoms of palpitations, dizziness, fatigue, or chest pain. Such attacks generally respond to antiarrhythmic agents (such as a single intravenous dose of propafenone or flecainide),3 which are usually administered under monitoring in hospital.

Here we propose that patients could self treat with oral propafenone or flecainide, using a “pill in the pocket” approach (thereby not needing to go to hospital), as suggested in recent national (National Institute for Health and Clinical Excellence) and international guidelines.4 5 For details of our methods, please see the box on bmj.com.

KEY POINTS

• Currently, patients without severe heart disease who have infrequent paroxysmal atrial fibrillation require hospital intervention for symptomatic episodes
• For selected patients, self treatment strategy is feasible, safe, and reduces hospital admissions and emergency department visits
• Eligible patients should not have a history of left ventricular dysfunction and should not have valvular or ischaemic heart disease, and they should have a history of infrequent symptomatic episodes of paroxysmal atrial fibrillation
• They should first be treated for symptoms at a specialist hospital unit, using oral flecainide or propafenone; if successful, the drug can be carried by the patient for self treatment when symptoms occur