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

Background: Class 1C antiarrhythmics are effective for treating atrial tachyarrhythmias, but their use is restricted in patients with coronary artery disease (CAD). Data on the safety of the use of 1C agents in patients with CAD in the absence of recent acute coronary syndromes are lacking.

Objective: To evaluate the safety and feasibility of treatment with 1C agents in patients with varying degrees of CAD in a large serial, real-world cohort.

Methods: We retrospectively identified all patients at our institution from January 2005 to February 2021 on a 1C agent (n=3445), and on sotalol or dofetilide (n=2216) as controls, excluding those with a prior history of VT, ICD placement, or non-revascularized MI. Baseline clinical characteristics included degree of CAD (categorized as: none, non-obstructive, or obstructive), other comorbid illness, and medication use. Clinical outcomes, including survival, were ascertained. We performed Cox regression analysis to evaluate the effect of 1C use on event free survival across varying degrees of CAD.

Results: After adjusting for baseline characteristics, there was an independent association between 1C use and event-free survival (compared to a Class III agent). However, there was an interaction between 1C use and degree of CAD demonstrating poorer event-free survival among those with obstructive CAD (HR 3.77, 95% CI: 1.66-8.59, p=0.002).

Conclusions: Among select patients with non-obstructive CAD and without a history of VT, 1C agents are not associated with increased mortality. Therefore, these agents may be an option to some patients in whom they are frequently restricted. Further prospective studies are warranted.




Kalyanam Shivkumar, MD, PhD, FACC 

CME Editor
Kenneth A. Ellenbogen, MD, FACC

Mahmoud Houmsse, MD, FACC

Important Dates
Date of Release: July 24, 2023
Term of Approval/Date of CME/MOC Expiration: July 23, 2024


Availability: On-Demand
Expires on Jul 23, 2024
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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