Abstract
Little is known about the effects of antiarrhythmic drugs on the atrial defibrillation threshold in humans. An early study with quinidine 1 showed a significant reduction in number of shocks and a decreased energy requirement to restore sinus rhythm in patients with chronic atrial fibrillation (AF). Quinidine was administered as a loading dose of 1,200 mg in 24 hours before direct current electrical cardioversion. In contrast, Södermark et al 2 could not show any difference in the atrial defibrillation threshold between patients with chronic AF or atrial flutter treated with quinidine (600 to 800 mg twice daily during 2.5 days) and patients not so treated before direct current electrical cardioversion. Flecainide, a class Ic antiarrhythmic drug, is being used more and more for the treatment of supraventricular tachycardias. Compared with quinidine, flecainide is less effective in the chemical cardioversion of chronic AF or atrial flutter to sinus rhythm. 3 Another difference might stem from the energy required for successful direct current electrical cardioversion in patients using flecainide. Because of the absence of data about the effects of flecainide on the atrial defibrillation threshold, we compared the energy required in patients undergoing direct current electrical cardioversion for chronic AF or atrial flutter with or without intravenously administered flecainide.
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