No Long-Term Benefit to a Short Course of Flecainide After AF Cardioversion

Atrial electrical remodeling is thought to underlie many of the frequent recurrences of atrial fibrillation (AF) after cardioversion. The effects of atrial remodeling are generally detrimental, but researchers have hypothesized that short-term antiarrhythmic drug therapy to keep patients in sinus rhythm for a month after cardioversion can lead to reverse remodeling and thus have a long-term effect, even after the drug is stopped.

This theory has now been tested in the German multicenter, manufacturer-supported Flec-SL trial, in which 635 patients with persistent AF were randomized after cardioversion to placebo or flecainide, either short-term (4 weeks) or long-term (6 months). Both short-term and long-term flecainide significantly reduced t…