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Real-world utilization of the pill-in-the-pocket method for terminating episodes of atrial fibrillation: data from

James A Reiffel1, Carina Blomström-Lundqvist2,3, Giuseppe Boriani4

  • 1Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons, c/o 202 Birkdale Lane, New York, NY 33458, USA.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|June 24, 2023
PubMed

Insights

The pill-in-the-pocket (PITP) strategy is frequently used for atrial fibrillation (AF) conversion in the US and Europe. However, significant deviations from guidelines indicate a need for improved physician education on appropriate PITP use.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) is a common cardiac arrhythmia.
  • The 'pill-in-the-pocket' (PITP) approach is a guideline-recommended strategy for acute AF conversion.
  • Current real-world usage of PITP has not been systematically evaluated.

Purpose of the Study:

  • To evaluate the current clinical utilization of the PITP strategy for atrial fibrillation.
  • To compare PITP usage patterns between the USA and European countries.
  • To identify deviations from guideline recommendations in PITP application.

Main Methods:

  • The study analyzed data from the Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) survey.
  • Survey questions focused on current PITP usage.
  • Data were stratified by geographic region (US vs. Europe) and physician specialty (cardiologists vs. electrophysiologists).

Main Results:

  • Clinicians in both the USA and Europe consider PITP for approximately 25% of patients.
  • PITP is predominantly considered for recent-onset AF with minimal or no structural heart disease, aligning with guidelines.
  • Significant deviations in PITP usage compared to guideline recommendations were observed.

Conclusions:

  • The pill-in-the-pocket strategy is frequently employed in clinical practice for atrial fibrillation.
  • There is a notable gap between guideline recommendations and actual clinical application of PITP.
  • Further physician education is necessary to ensure appropriate and optimal use of the PITP strategy.
Abstract

Keywords:
Atrial fibrillationCardioversionPharmacologicPill-in-the-pocketTermination

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