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

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. © 2025 Elsevier B.V., All rights reserved.