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Pilot study: Noninvasive monitoring of oral flecainide's effects on atrial electrophysiology during persistent human atrial fibrillation using the surface electrocardiogram

Husser, D; Binias, KH; Stridh, Martin LU ; Sörnmo, Leif LU ; Olsson, Bertil LU ; Molling, J; Geller, C; Klein, HU and Bollmann, A (2005) In Annals of Noninvasive Electrocardiology 10(2). p.206-210
Abstract
Background: The relation between flecainide's plasma level and its influence on human atrial electrophysiology during acute and maintenance therapy of atrial fibrillation (AF) is unknown. Therefore, this study determined flecainide plasma levels and atrial fibrillatory rate obtained from the surface ECG during initiation and early maintenance of oral flecainice in patients with persistent lone AF and assessed their relationship. Methods and Results: In 10 patients (5 males, mean age 63 14 years, left atrial diameter 46 +/- 3 mm) with persistent lone AF, flecainide was administered as a single oral bolus (day 1) followed by 200-400 mg/day (days 2-5). The initial 300 mg flecainide bolus resulted in therapeutic plasma levels in all patients... (More)
Background: The relation between flecainide's plasma level and its influence on human atrial electrophysiology during acute and maintenance therapy of atrial fibrillation (AF) is unknown. Therefore, this study determined flecainide plasma levels and atrial fibrillatory rate obtained from the surface ECG during initiation and early maintenance of oral flecainice in patients with persistent lone AF and assessed their relationship. Methods and Results: In 10 patients (5 males, mean age 63 14 years, left atrial diameter 46 +/- 3 mm) with persistent lone AF, flecainide was administered as a single oral bolus (day 1) followed by 200-400 mg/day (days 2-5). The initial 300 mg flecainide bolus resulted in therapeutic plasma levels in all patients (range 288-629 ng/ml) with no side effects. Flecainide plasma levels increased on day 3 and remained stable thereafter. Day 5 plasma levels were lower (508 +/- 135 vs 974 :E 276 ng/ml, P = 0.009) in patients with daily mean flecainide doses of 200 mg compared to patients with higher maintenance doses. Fibrillatory rate obtained from the surface electrocardiogram measuring 378 +/- 17 fpm at baseline was reduced to 270 +/- 18 fpm (P < 0.001) after the flecainice bolus but remained stable thereafter. Fibrillatory rate reduction was independent of flecainide plasma levels or clinical variables. Conclusion: A 300 mg oral flecainide bolus is associated with electrophysio logic effects that are not increased during early maintenance therapy in persistent human lone AF In contrast to drug plasma levels, serial analysis of fibrillatory rate allows monitoring of individual drug effects on atrial electrophysiology. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Noninvasive Electrocardiology
volume
10
issue
2
pages
206 - 210
publisher
Wiley-Blackwell
external identifiers
  • pmid:15842433
  • wos:000228826100012
  • scopus:18444405841
ISSN
1082-720X
DOI
10.1111/j.1542-474X.2005.05616.x
language
English
LU publication?
yes
id
7703d3f9-1c00-455e-b79b-acd98e9ad8d1 (old id 243830)
date added to LUP
2007-08-22 10:39:41
date last changed
2017-03-19 03:31:26
@article{7703d3f9-1c00-455e-b79b-acd98e9ad8d1,
  abstract     = {Background: The relation between flecainide's plasma level and its influence on human atrial electrophysiology during acute and maintenance therapy of atrial fibrillation (AF) is unknown. Therefore, this study determined flecainide plasma levels and atrial fibrillatory rate obtained from the surface ECG during initiation and early maintenance of oral flecainice in patients with persistent lone AF and assessed their relationship. Methods and Results: In 10 patients (5 males, mean age 63 14 years, left atrial diameter 46 +/- 3 mm) with persistent lone AF, flecainide was administered as a single oral bolus (day 1) followed by 200-400 mg/day (days 2-5). The initial 300 mg flecainide bolus resulted in therapeutic plasma levels in all patients (range 288-629 ng/ml) with no side effects. Flecainide plasma levels increased on day 3 and remained stable thereafter. Day 5 plasma levels were lower (508 +/- 135 vs 974 :E 276 ng/ml, P = 0.009) in patients with daily mean flecainide doses of 200 mg compared to patients with higher maintenance doses. Fibrillatory rate obtained from the surface electrocardiogram measuring 378 +/- 17 fpm at baseline was reduced to 270 +/- 18 fpm (P &lt; 0.001) after the flecainice bolus but remained stable thereafter. Fibrillatory rate reduction was independent of flecainide plasma levels or clinical variables. Conclusion: A 300 mg oral flecainide bolus is associated with electrophysio logic effects that are not increased during early maintenance therapy in persistent human lone AF In contrast to drug plasma levels, serial analysis of fibrillatory rate allows monitoring of individual drug effects on atrial electrophysiology.},
  author       = {Husser, D and Binias, KH and Stridh, Martin and Sörnmo, Leif and Olsson, Bertil and Molling, J and Geller, C and Klein, HU and Bollmann, A},
  issn         = {1082-720X},
  language     = {eng},
  number       = {2},
  pages        = {206--210},
  publisher    = {Wiley-Blackwell},
  series       = {Annals of Noninvasive Electrocardiology},
  title        = {Pilot study: Noninvasive monitoring of oral flecainide's effects on atrial electrophysiology during persistent human atrial fibrillation using the surface electrocardiogram},
  url          = {http://dx.doi.org/10.1111/j.1542-474X.2005.05616.x},
  volume       = {10},
  year         = {2005},
}