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Antiarrhythmic drugs are standard first-line therapy for symptomatic atrial fibrillation (AF), but chronic use has limitations, including twice- or thrice-daily administration, cost, and the risk for proarrhythmia. A "pill in the pocket" approach to AF management (usually a single dose of flecainide or propafenone upon AF onset) has been 58% to 95% effective in inpatient settings. But what about outpatient settings?
To find out, researchers in Italy studied 268 patients who presented to the emergency room with AF that had started within the previous 48 hours; all had histories of infrequent, hemodynamically well-tolerated abrupt onset of palpitations. Among the many exclusion criteria were preexcitation, conduction disease, a prior AF episod…