Flecainide may help achieve sinus rhythm in young rheumatic AF patients undergoing MVR

A recent study found that oral flecainide, a medication used to treat certain heart rhythm disorders, could be a valuable option for patients who continue to experience atrial fibrillation (AF) after successful mitral valve replacement (MVR). The findings were published in Indian Heart Journal.

The study, which involved 25 patients with chronic rheumatic AF following MVR, revealed promising outcomes. The patients had an average age of 34.4 years and had been experiencing AF for an average of 3.6 years. Researchers administered oral flecainide to these patients to assess its effectiveness in converting and maintaining sinus rhythm (SR), which is the normal heart rhythm.

Results from the study showed that a single oral dose of flecainide successfully restored SR in 24% of patients, while 84% achieved SR after undergoing direct current cardioversion (DCC) at 24 hours. The maintenance of SR at the six-month mark was observed in 69.5% of patients who received a mean flecainide dose of 93.10 ± 9.40 mg. Importantly, the medication was well tolerated, and no significant adverse effects were noted in terms of heart rhythm parameters.

Patients who were successfully converted to SR demonstrated improved functional status and quality of life scores, as well as higher left atrial (LA) strain values, a measure of cardiac performance. The study also identified certain predictive factors for successful SR maintenance at six months. Patients with a baseline LA diameter of 61 mm or less, AF duration of four years or less, and LA strain greater than 21% showed higher rates of SR maintenance.

The findings of this study suggest that oral flecainide could be a safe and effective treatment option for patients with chronic rheumatic AF following MVR. The maintenance of normal heart rhythm was achieved in a substantial percentage of patients, potentially leading to improved overall health outcomes and quality of life.

Reference:

Tripathi, U., Kapoor, A., Kumar Agarwal, S., Tewari, P., Pande, S., Chandra, B., Sahu, A., Khanna, R., Kumar, S., Garg, N., & Tewari, S. (2023). Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillation. In Indian Heart Journal. Elsevier BV. https://doi.org/10.1016/j.ihj.2023.07.001