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European Heart Journal 1994 15(10):1403-1408;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Atrial flutter can be terminated by a class III antiarrhythmic drug but not by a class IC drug

H. J. G. M. CRIJNS, I. C. VAN GELDER, J. H. KINGMA*,{dagger}, P. H. J. M. DUNSELMAN*,{ddagger}, A. T. M. GOSSELINK and K. I. LIE

From the Departments of Cardiology, Thoraxcenter The Netherlands
*Clinical Pharmacology, University Hospital Groningen The Netherlands
{dagger}Antonius Hospital Nieuwegein The Netherlands
{ddagger}Ignatius Hospital Breda The Netherlands

Received 29 October 1993; revised 11 April 1994; .

Correspondence: Harry J. G. M. Crijns, MD, Department of Cardiology, Thoraxcenter, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Abstract

In atrial flutter, chemical conversion with class I drugs is often unsuccessful, whereas class III drugs seem more promising. The different electrophysiological effects of these drugs may explain this discrepancy. To date, only experimental data show the differential effects of these drugs on conversion rate and atrial flutter cycle length.

This study evaluates the effects of the class IC antiarrhythmic drug flecainide, and of dofetilide, a new class III drug, on conversion rate and flutter cycle length in patients with atrial flutter. Flecainide (11 patients) was given as an intravenous bolus of 2 mg. kg–1 in 10 min and dofetilide (10 patients) as a maximum intravenous bolus of 8 µg. kg–1 in 15 min. Baseline characteristics were comparable between both groups. Only one patient treated with flecainide converted to sinus rhythm. This patient showed the largest flutter cycle length increase (280 to 420 ms). By contrast, seven of the 10 patients treated with dofetilide converted to sinus rhythm. Patients treated with flecainide showed a significantly larger increase in atrial flutter cycle length at the end of the infusion compared to the dofetilide-treated patients (from 226 ± 28 to 317 ± 52 ms vs from 221 ± 26 to 239 ± 39 ms, respectively). In conclusion, dofetilide is more effective than flecainide in the conversion of atrial flutter to sinus rhythm, despite the fact that flecainide produced a more prolonged flutter cycle length. Thus, action potential prolongation in the absence of conduction slowing seems more effective in terminating human atrial flutter than depression of the excitability.

Key Words: Atrial flutter • class IC antiarrhythmic drug • class III antiarrhythmic drug • flutter cycle length


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