Propafenone use in coronary artery disease patients undergoing atrial fibrillation ablation

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Antiarrhythmic drugs (AADs) are commonly prescribed post-atrial fibrillation (AF) ablation.
• The efficacy and safety of Class IC AADs, specifically propafenone, in AF ablation patients with coronary artery disease (CAD) remain unclear.
• This study investigates propafenone versus amiodarone in CAD patients post-AF ablation.

Purpose of the Study:

• To evaluate the safety and efficacy of propafenone compared to amiodarone in patients with mild to moderate coronary artery disease (CAD) undergoing atrial fibrillation (AF) ablation.
• To assess the risk of ventricular arrhythmias and mortality in these patient groups.

Main Methods:

• A retrospective, longitudinal cohort study included 263 patients on propafenone and 499 on amiodarone post-AF ablation.
• Propensity score matching created comparable groups of 212 patients each.
• The primary outcome was a composite of ventricular arrhythmic events, including sudden cardiac death, sustained or non-sustained ventricular tachycardia (NSVT). Secondary outcomes included cardiovascular and non-cardiovascular mortality.

Main Results:

• After propensity score matching, baseline characteristics were well-balanced between the propafenone and amiodarone groups.
• At 12-month follow-up, no significant difference in the primary outcome (NSVT) was observed between groups (4.7% incidence).
• Propafenone use was not independently associated with an increased risk of ventricular arrhythmic events; age and diabetes were significant predictors.

Conclusions:

• Propafenone demonstrates a similar safety profile to amiodarone in patients with mild to moderate CAD following AF ablation.
• Propafenone use was not linked to an increased incidence of major arrhythmic events or mortality in this population.