• Dante Antonelli, Alexander Feldman, Nahum A Freedberg, Aziz Darawsha, and Tiberio Rosenfeld.
• Department of Cardiology and Emergency Room, HaEmek Medical Center, Afula. antonelli_dante@hotmail.com
• Harefuah. 2006 May 1; 145 (5): 342-4, 398.

IntroductionSince the removal of intravenous propafenone from the Israeli market, flecainide is the only intravenous antiarrhythmic class 1C drug available nowadays in Israel.AimThe study aimed to report our experience of intravenous flecainide administration in the treatment of paroxysmal atrial fibrillation (PAF) in the Emergency Room (ER).MethodsPatients with AF lasting > 1 hour and <48 hour duration were considered possible candidates for entry into the study. Exclusion criteria were clinical signs of congestive heart failure, acute coronary syndrome, electrolyte imbalances, significant hepatic and renal disease, and any previously documented conduction disturbance. Flecainide was administered as a bolus dose of 2mg/kg in 10 minutes (maximum 150 mg). The patients with a ventricular response > 130 beats/min received intravenous verapamil or metoprolol in order to reduce the ventricular rate. Efficacy was defined as conversion to sinus rhythm (SR) within 120 minutes of starting medication.ResultsTwenty three consecutive patients were enrolled in the study. Their mean age was 60 +/- 19 years; the mean ventricular response at admission was 128 +/- 26 beats/min. SR was achieved in 10 patients (43%) after the intravenous bolus of flecainide (10 minutes) and in 17 patients (74%) 120 minutes after the beginning of the therapy.ComplicationsHypotension (systolic blood pressure < 90 mmHg) was reported in 1 patient and QRS enlargement was seen in 1 patient.ConclusionIntravenous flecainide has effective and rapid action in the conversion of PAF and its administration is safe in the treatment of this arrhythmia in the ER.

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