Supraventricular tachycardia: flecainide prevented symptoms more effectively than verapamil.

Clinical bottom line (level 1b)

  1. Patients with recurrent paroxysmal supraventricular tachycardia who took flecainide compared with verapamil were less likely to have symptomatic episodes (NNT = 6 at 8 months) .
  2. There was no clear difference in the number of patients discontinuing medication.
Dorian et al: American Journal of Cardiology 1996; 77: 89A-95A
Expires October 2001

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 32 acute hospitals, North America, Europe

121 patients (aged mean 51 years, 71% female) recurrent paroxysmal supraventricular tachycardia (regular with rate > 120 bpm, normal QRS or functional bundle branch block and no evidence of atrioventricular dissociation)

Excluded if
  • coexisting atrial fibrillation or flutter
  • previous MI or unstable angina
  • history of sustained ventricular tachycardia
  • congestive heart failure
  • high-degree atrioventricular block
  • previous ventricular pre-excitation
  • concomitant antiarrhythmics (except beta-blockers)


    • Control Group: (n = 58, 58 analysed): verapamil 80 mg po three times daily, increased to 480 mg three to four times daily
    Experimental Group: (n = 63, 63 analysed): flecainide 50 mg po twice daily, increase every four days to a maximum of 300 mg per day

    100% followed for 8 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    still had symptomatic attacks 8 months 51
    (87.9%)    		 44
    (69.8%)    		 21%
    (4% to 34%)    		 18.1%
    (3.99% to 32.2%)    		 6
    (3 to 25)
    discontinued therapy 8 months 29
    (50.0%)    		 29
    (46.0%)    		 8%
    (-33% to 36%)    		 3.97%
    (-13.8% to 21.8%)    		 25
    (NNT = 5 to infinity;
    NNH = 7 to infinity)
    adverse effects leading to discontinuation 8 months 14
    (24.1%)    		 12
    (19.1%)    		 21%
    (-56% to 60%)    		 5.09%
    (-9.58% to 19.8%)    		 20
    (NNT = 5 to infinity;
    NNH = 10 to infinity)

    Citation

    1. Dorian P, Naccarelli GV, Coumel P, et al: a randomized comparison of flecainide versus verapamil in paroxysmal supraventricular tachycardia. American Journal of Cardiology 1996; 77: 89A-95A
    Search Terms: atrial fibril* in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient supraventricular tachycardia
    Intervention or Exposure flecainide
    Comparison verapamil
    Outcome symptomatic episodes, adverse effects