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Long-term outcomes in patients treated with flecainide for atrial fibrillation with stable coronary artery disease

Tyson S Burnham1, Heidi T May2, Tami L Bair2

  • 1Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT.

American Heart Journal
|September 19, 2021
PubMed

Insights

Flecainide showed a favorable safety profile for atrial fibrillation patients with stable coronary artery disease, with lower mortality and adverse events compared to class-3 antiarrhythmic drugs. Further trials are needed to confirm these findings for flecainide use in this population.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Class 1C antiarrhythmic drugs (AAD) carry risks for ventricular arrhythmias post-myocardial infarction.
  • Guidelines advise against 1C AADs in stable coronary artery disease (CAD).
  • Long-term data on 1C AADs for atrial fibrillation (AF) in CAD patients without prior myocardial infarction are limited.

Purpose of the Study:

  • To evaluate the safety and efficacy of flecainide versus class-3 AADs in AF patients with stable CAD.
  • To compare outcomes including mortality, heart failure hospitalization, ventricular tachycardia, and MACE at 3 years.

Main Methods:

  • Two patient populations were analyzed from 24,315 patients initiating AADs.
  • Population 1: Propensity-matched AF patients with CAD (flecainide vs. class-3 AAD).
  • Population 2: AF patients with prior percutaneous coronary intervention or coronary artery bypass graft (flecainide vs. class-3 AAD).

Main Results:

  • In population 1, flecainide was associated with significantly lower 3-year rates of mortality, HF hospitalization, MACE, and VT compared to class-3 AADs.
  • In population 2, flecainide showed numerically lower adverse event rates, though not statistically significant.
  • Specific 3-year outcomes for population 1: mortality (9.1% vs 19.3%), HF hospitalization (12.5% vs 18.3%), MACE (22.9% vs 36.6%), VT (5.8% vs 8.5%).

Conclusions:

  • Flecainide demonstrates a favorable safety profile compared to class-3 AADs in select AF patients with stable CAD.
  • Current guideline exclusions for flecainide in this patient group may warrant re-evaluation.
  • Prospective trials are recommended to confirm flecainide's safety and efficacy in AF patients with CAD.
Abstract

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