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Flecainide use in arrhythmic patients who have structural heart disease

Naruepat Sangpornsuk1,2,3,4, Voravut Rungpradubvong5,2,3, Tachawut Tiensantisuk1,2,3

  • 1Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.

Therapeutic Advances in Drug Safety
|February 13, 2025
PubMed

Insights

Flecainide use in patients with structural heart disease did not increase the incidence of ventricular arrhythmias or mortality. This study suggests flecainide may be safe for certain structural heart conditions beyond ischemic heart disease.

Area of Science:

  • Cardiology
  • Pharmacology
  • Electrophysiology

Background:

  • Current guidelines limit flecainide use in patients with normal or minimal structural heart disease.
  • The CAST study indicated increased mortality with long-term flecainide in post-myocardial infarction patients with reduced ejection fraction.
  • However, subsequent studies suggest safety in other structural heart diseases.

Purpose of the Study:

  • To investigate the incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with structural heart disease compared to those without, when treated with flecainide.
  • To evaluate the safety of flecainide in a diverse patient population with varying degrees of structural heart disease.

Main Methods:

  • Retrospective study of 447 patients who received at least one dose of flecainide in the past 5 years.
  • Included 336 patients, categorizing them into structural heart disease (47 patients) and non-structural heart disease groups.
  • Assessed baseline characteristics, flecainide indications, echocardiography, and evaluated ventricular arrhythmias and all-cause mortality after 1 year.

Main Results:

  • Ventricular arrhythmias occurred in 4.7% of the structural heart disease group and 1.1% of the non-structural heart disease group.
  • No statistically significant association was found between structural heart disease and increased incidence of ventricular arrhythmias (OR = 4.8, p = 0.139).
  • Patients experiencing arrhythmias in the structural heart group had prior history of arrhythmias.

Conclusions:

  • Flecainide use did not result in increased ventricular arrhythmias or mortality in patients with structural heart disease in this cohort.
  • The findings suggest potential safety of flecainide in structural heart diseases beyond ischemic heart disease.
  • Further prospective studies are recommended to confirm flecainide's safety profile in specific non-ischemic structural heart conditions.
Abstract

Keywords:
coronary artery diseaseflecainideleft ventricular dysfunctionleft ventricular hypertrophystructural heart diseaseventricular arrhythmia

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