Individuals who only rarely experience episodes of atrial fibrillation may be able to avoid taking their medication every day: for them, on-demand therapy can be useful if it has been discontinued under medical supervision beforehand.
Between 2007 and 2020, 273 patients received “standby” therapy for atrial fibrillation at the University Hospital of Pennsylvania: They were provided with flecainide or propafenone as rescue medication in the event that they developed atrial fibrillation. 61 percent of them received the first dose of the drug during a hospital stay or in the emergency room.
Overall, side effects were rare, but when they did, the majority were severe: Eleven patients had side effects when they first started, seven were serious, and four required urgent intervention. Five of the seven patients with serious side effects had not taken the first dose under medical supervision. The researchers, who published the study in the journal JACC Clinical Electrophysiology, therefore believe it is safer if the first dose is monitored.
People who took a low dose of less than 300 milligrams of flecainide or less than 600 milligrams of propafenone were less likely to experience side effects. However, the therapy was not quite as effective for them either, so that they needed external electrical impulses somewhat more frequently to bring the heart back into rhythm (electrical cardioversion).
Which: DOI 10.1016/j.jacep.2022.07.010