The Feasibility and Safety of Flecainide Use Among Patients with Varying Degrees of Coronary Disease (JCEP July 2023)-Article: The Feasibility and Safety of Flecainide Use Among Patients with Varying Degrees of Coronary Disease

Article: The Feasibility and Safety of Flecainide Use Among Patients with Varying Degrees of Coronary Disease

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This study explores the safety and feasibility of using Class IC antiarrhythmic drugs, such as flecainide, among patients with varying degrees of coronary artery disease (CAD). The research retrospectively analyzed data from 3,445 patients on Class IC agents and 2,216 control patients on Class III agents, such as sotalol or dofetilide, at Emory University between January 2005 and February 2021. Patients with a history of ventricular tachycardia, implantation of a cardioverter-defibrillator, or unrevascularized myocardial infarction were excluded.<br /><br />Key Findings:<br />1. Patients on Class IC agents tended to be younger and have a lower burden of obstructive CAD compared to those on Class III agents.<br />2. Adjusted results showed Class IC use to be independently associated with improved event-free survival compared to Class III agents.<br />3. There was a significant interaction between the degree of CAD and the use of Class IC agents. Specifically, patients with obstructive CAD (OB-CAD) on Class IC agents demonstrated poorer event-free survival compared to those on Class III agents.<br />4. No significant interaction was found between Class IC use and nonobstructive CAD (NO-CAD) or heart failure, suggesting these agents might be safe for selected patients with these conditions.<br /><br />The study found that in selected patients without severe CAD or heart failure, Class IC agents could be a viable option for treating atrial fibrillation and other tachyarrhythmias. However, due to poorer outcomes among those with OB-CAD when using Class IC agents compared to Class III agents, caution is advised. Further prospective studies were recommended to validate these findings and potentially revise guidelines on the use of Class IC agents in patients with CAD and heart failure.

Keywords

Class IC antiarrhythmic drugs

flecainide

coronary artery disease

CAD

Class III agents

sotalol

dofetilide

event-free survival

obstructive CAD

nonobstructive CAD