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Meta-Analysis
. 2018 Mar;54(3):320-327.
doi: 10.1016/j.jemermed.2017.11.016.

Intravenous Flecainide for Emergency Department Management of Acute Atrial Fibrillation

Gerard C Markey  1 , Nigel Salter  2 , John Ryan  2
Affiliations
Meta-Analysis

Intravenous Flecainide for Emergency Department Management of Acute Atrial Fibrillation

Gerard C Markey et al. J Emerg Med. 2018 Mar.

Abstract

Background: Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these patients have recent-onset AF (<48 h). The poor prognosis associated with AF is being increasingly recognized, and there is some evidence for better outcomes in younger patients with recent-onset AF when sinus rhythm is restored. Flecainide is recommended in the latest international guidelines for cardioversion of recent-onset AF, but its safety and efficacy relative to other recommended agents are unclear.

Objective: Our aim was to clarify the Level 1 evidence for the use of i.v. flecainide in acute AF.

Methods: We performed a systematic review and meta-analysis of the literature. Medline, Ovid, Embase, and Cochrane Central databases were searched for relevant studies. Only randomized controlled trials (RCTs) of i.v. flecainide for acute conversion of recent-onset AF were selected for meta-analysis.

Results: Four hundred and three studies were screened, of which 11 RCTs were eligible for meta-analysis. Flecainide had high efficacy for cardioversion within 2 h (number needed to treat [NNT] = 1.8). Efficacy was superior to propafenone, amiodarone, procainamide, ibutilide, and sotalol (NNT = 4.3). There was no statistically significant difference in pro-dysrhythmia compared to these anti-dysrhythmics or placebo.

Conclusions: Intravenous flecainide cardioversion could be a safe and effective option for emergency physicians to restore sinus rhythm in selected patients with acute AF.

Keywords: atrial fibrillation; cardioversion; flecainide; recent onset.

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Comment in

  • Markey et al. Reply to de Souza.
    Markey G, Salter N, Ryan J. Markey G, et al. J Emerg Med. 2018 Oct;55(4):572. doi: 10.1016/j.jemermed.2018.06.041. Epub 2018 Aug 20. J Emerg Med. 2018. PMID: 30139511 No abstract available.
  • Atrial Fibrillation: How Long Has It Been?
    Mills LD. Mills LD. J Emerg Med. 2018 Oct;55(4):570. doi: 10.1016/j.jemermed.2018.06.040. Epub 2018 Aug 22. J Emerg Med. 2018. PMID: 30143330 No abstract available.
  • In Reply to Markey et al.
    deSouza IS, Benabbas R. deSouza IS, et al. J Emerg Med. 2018 Oct;55(4):571. doi: 10.1016/j.jemermed.2018.04.065. Epub 2018 Aug 22. J Emerg Med. 2018. PMID: 30143331 No abstract available.

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