Pill-In-The-Pocket

The ‘Pill-in-the-pocket’ management of paroxysmal atrial fibrillation has been shown to be an effective and safe method of restoring a normal, sinus rhythm in a carefully selected group of patients. It involves taking a tablet, usually Flecainide or Propafenone, after recognizing the onset of AF on a PRN basis. Data from some studies show that the pill-in-the-pocket strategy with flecainide and propafenone is effective for all the arrhythmic episodes in more than 80 percent of patients with recurrent atrial fibrillation, after selection of patients on the basis of clinical features and the results of in-hospital treatment. Only some patients are suitable for the ‘Pill-in-the-Pocket’ method of treatment. They should:

• Be able to recognize the onset of the Atrial Fibrillation.

• Have attacks that happen no more frequently than at weekly or preferably monthly intervals.

• Have no significant underlying heart disease.

• Have no disabling symptoms during an attack (fainting, severe chest pain or breathlessness).

• Be able to understand the proper way of taking the medication.

Patients with infrequent SVT episodes may only need pharmacotherapy on an intermittent basis as well, or what has been described as the “pill-in-the-pocket” approach. Those experiencing SVT not more than a few times per year, but with episodes lasting one hour or longer, may be treated using this approach. This is typically done with verapamil (40 to 160 mg) in patients without pre-excitation or a beta blocker in patients without chronic obstructive pulmonary disease or asthma.