Basic Research in Cardiology

, Volume 100, Issue 2, pp 112–121 | Cite as

Electrophysiological effects of flecainide and sotalol in the human atrium during persistent atrial fibrillation

  • P. Kirchhof
  • M. Engelen
  • M. R. Franz
  • M. Ribbing
  • K. Wasmer
  • G. Breithardt
  • W. Haverkamp
  • L. Eckardt
ORIGINAL CONTRIBUTION

Abstract

Aims

Atrial fibrillation (AF) shortens the atrial action potential and the atrial refractory period. These changes promote persistence of AF. Pharmacological prolongation of atrial action potential duration (APD) may therefore help to prevent recurrent AF. In addition to prolonging APD, sodium channel blockers may prevent AF by inducing post–repolarization refractoriness (PRR). We studied whether two antiarrhythmic drugs (sotalol, flecainide) prolong APD or induce PRR in the fibrillating human atrium.

Methods

In 12 patients with persistent AF (11 male, 58 ± 5 yrs, 27 ± 7 months duration of AF), we recorded monophasic action potentials from the right atrial appendage and inferior right atrium at baseline and 15 minutes after intravenous administration of sotalol (1.5 mg/kg) or flecainide (2 mg/kg). APD and effective refractory periods (ERP) were determined.

Results

Both drugs prolonged APD90 during AF (flecainide from 109 ± 7 ms to 137 ± 10 ms, sotalol from 108 ± 6 ms to 131 ± 8 ms, both p < 0.05 vs. baseline). Sotalol prolonged ERP in parallel to APD (from 119 ± 8 ms to 139 ± 8 ms, p < 0.05). Flecainide induced PRR by prolonging ERP more than APD90 (from 134 ± 9 ms to 197 ± 28 ms, p < 0.05 vs. baseline and vs. sotalol).

Conclusions

Flecainide and sotalol prolong the atrial action potential during atrial fibrillation in humans. In addition, flecainide induces atrial PRR. These electrophysiological effects may reduce AF recurrences and prevent their persistence.

Key words

Atrial fibrillation antiarrhythmic agents action potential refractoriness human pharmacology electrophysiology 

Abbreviations

AF

Atrial Fibrillation

APD

Action Potential Duration

ERP

Effective Refractory Period

MAP

Monophasic Action Potential

PRR

Post–Repolarization Refractoriness

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Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • P. Kirchhof
    • 1
  • M. Engelen
    • 1
  • M. R. Franz
    • 2
  • M. Ribbing
    • 1
  • K. Wasmer
    • 1
  • G. Breithardt
    • 1
  • W. Haverkamp
    • 1
    • 3
  • L. Eckardt
    • 1
  1. 1.Medizinische Klinik und Poliklinik C Kardiologie und AngiologieUniversitätsklinikum MünsterMünsterGermany
  2. 2.Departments of Pharmacology and CardiologyGeorgetown University and VA Medical CentersWashington DCUSA
  3. 3.Department of CardiologyHumboldt-University Campus VirchowBerlinGermany

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