Clinical review for general practice

ISSN (Print) 2713-2552
ISSN (Online) 2782-5671
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FULLSCREEN > Archive > 2025 > Vol 6, №3 (2025) > The «pill-in-the-pocket» strategy: a fresh look at termination of paroxysmal atrial fibrillation

The «pill-in-the-pocket» strategy: a fresh look at termination of paroxysmal atrial fibrillation

Andrey V. Syrov, Aida I. Tarzimanova, Vladimir L. Doshchitsin

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  • Abstract
  • About the Author
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Abstract

The strategy of paroxysmal AF termination involving taking the loading dose of a tablet formulation (“pill-in-the-pocket” strategy) becomes more and more popular in clinical practice. The “pill-in-the-pocket” strategy advantages include rapid and safe sinus rhythm restoration, including by patient on his/her own, which makes it possible to reduce the cost of medical services and significantly improve the patients’ quality of life. The drug of choice for the “pill-in-the-pocket” strategy is propafenone, the class 1C antiarrhythmic. The use of this drug has been studied in patients with the broad range of disorders; it has shown high efficacy and safety when used to terminate paroxysmal AF in multiple clinical trials. The rapid antiarrhythmic effect together with the availability of two dosage forms, oral and infusion, make it possible to use propafenone at all stages of care provision: in inpatient and outpatient settings, by emergency doctors and patients on their own.
Keywords: pill-in-the-pocket, propafenone, atrial fibrillation.

About the Author

Andrey V. Syrov1, Aida I. Tarzimanova2, Vladimir L. Doshchitsin3

1 Patrice Lumumba People’s Friendship University of Russia (RUDN University), Moscow, Russia

2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

3 Pirogov Russian National Research Medical University, Moscow, Russia

References

1. Фибрилляция и трепетание предсердий. Клинические рекомендации Минздрава России 2020 г. Российский кардиологический журнал. 2021;26(7):4594. DOI: 10.15829/1560-4071-2021-4594
Atrial fibrillation and flutter. Clinical recommendations of the Russian Ministry of Health 2020. Russian Journal of Cardiology. 2021;26(7):4594. DOI: 10.15829/1560-4071-2021-4594 (in Russian).
2. Van Gelder IC, Rienstra M, Bunting KV et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): Developed by the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO). Eur Heart J 2024;45(36):3314-414. DOI: 10.1093/eurheartj/ehae176
3. Reiffel JA, Blomstron-Lundqvist C et al. Use of the “pill in the pocket” approach for atrial fibrillation termination as determined from the Antiarrhythmic Medication for Atrial Fibrillation (AIM-AF) study: A physician survey on the prescription of antiarrhythmic drugs in the USA and Europe. American Heart Association Annual Scientific Sessions. Circulation 2021;144 (Suppl 1), article 10986.
4. Reiffel JA, Capucci A. "Pill in the Pocket" Antiarrhythmic Drugs for Orally Administered Pharmacologic Cardioversion of Atrial Fibrillation. Am J Cardiol 2021;140:55-61. DOI: 10.1016/j.amjcard.2020. 0.063. PMID: 33144165.
5. Markman TM, Jarrah AA, Tian Y et al. Safety of Pill-in-the-Pocket Class 1C Antiarrhythmic Drugs for Atrial Fibrillation. JACC Clin Electrophysiol 2022;8(12):1515-20. DOI: 10.1016/j.jacep.2022.07.010.
6. Kirchhof P, Camm AJ, Goette A et al. EAST-AFNET 4 Trial Investigators. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med 2020;383(14):1305-16. DOI: 10.1056/NEJMoa2019422. PMID: 32865375.
7. Capucci A. Pill in the Pocket: A Safe and Useful Antiarrhythmic Strategy. JACC Clin Electrophysiol 2022;8(12):1521-2. DOI: 10.1016/j.jacep. 2022.11.001. PMID: 36543502.
8. Фомина И.Г., Тарзиманова А.И., Ветлужский А.В. и др. Пропафенон при восстановлении синусового ритма у больных с персистирующей формой фибрилляции предсердий. «ПРОМЕТЕЙ» – открытое, мультицентровое, пилотное исследование в Российской Федерации. Кардиоваскулярная терапия и профилактика. 2005;4(4):66-9.
Fomina I.G., Tarzimanova A.I., Vetluzhsky A.V. et al. Propafenone in restoring sinus rhythm in patients with persistent atrial fibrillation. PROMETHEUS is an open, multicenter, pilot study in the Russian Federation. Cardiovascular therapy and prevention. 2005;4(4):66-9 (in Russian).
9. Татарский Б.А. Стратегия «таблетка в кармане» при купировании фибрилляции предсердий. Российский кардиологический журнал. 2005;4(54):72-5.
Tatarsky B.A. The "Pill in the Pocket" strategy for atrial fibrillation relief. Russian Journal of Cardiology. 2005;4(54):72-5 (in Russian).

Портал CON-MED.RU:
https://con-med.ru/magazines/klinicheskiy_razbor_v_obshchey_meditsine/klinicheskiy_razbor_v_obshchey_meditsine-03-2025/strategiya_tabletka_v_karmane_novyy_vzglyad_na_kupirovanie_paroksizma_fibrillyatsii_predserdiy/

For citation: Syrov A.V., Tarzimanova A.I., Doshchitsin V.L. The «pill-in-the-pocket» strategy: a fresh look at termination of paroxysmal atrial fibrillation. Clinical review for general practice. 2025; 6 (3): 42–46 (In Russ.). DOI: 10.47407/kr2024.6.3.00580


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