B-PO03-115 ANTIARRHYTHMIC MEDICATION FOR ATRIAL FIBRILLATION (AIM-AF) STUDY: A PHYSICIAN SURVEY OF ABLATION AND ANTIARRHYTHMIC DRUG USE IN THE USA AND EUROPE

Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.

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Flecainide How and When: A Practical Guide in Supraventricular Arrhythmias

Journal of Clinical Medicine ◽

10.3390/jcm10071456 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1456

Author(s):

Carlo Lavalle ◽

Michele Magnocavallo ◽

Martina Straito ◽

Luca Santini ◽

Giovanni Battista Forleo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ventricular Tachycardia ◽

Drug Treatment ◽

Sinus Rhythm ◽

Antiarrhythmic Drug ◽

Safety Profile ◽

Patient Management ◽

Clinical Use ◽

Supraventricular Arrhythmias ◽

Sinus Rhythm Maintenance

Transcatheter ablation was increasingly and successfully used to treat symptomatic drug refractory patients affected by supraventricular arrhythmias. Antiarrhythmic drug treatment still plays a major role in patient management, alone or combined with non-pharmacological therapies. Flecainide is an IC antiarrhythmic drug approved in 1984 from the Food and Drug Administration for the suppression of sustained ventricular tachycardia and later for acute cardioversion of atrial fibrillation and for sinus rhythm maintenance. Currently, flecainide is mostly used for sinus rhythm maintenance in atrial fibrillation (AF) patients without structural cardiomyopathy although recent studies enrolling different patient populations have demonstrated a good effectiveness and safety profile. How should we interpret the results of the CAST after the latest evidence? Is it possible to expand the indications of flecainide, and therefore, its use? This review aims to highlight the main characteristics of flecainide, as well as its optimal clinical use, delineating drug indications and contraindications and appropriate monitoring, based on the most recent evidence.

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