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Original Article
Submitted: 2021-06-20
Accepted: 2022-05-23
Published online: 2022-12-07
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Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting

Boldizsar Kovacs12, Haci Yakup Yakupoglu123, Urs Eriksson124, Nazmi Krasniqi12, Firat Duru124
DOI: 10.5603/CJ.a2022.0116
·
Pubmed: 36510792
Affiliations
  1. Department of Cardiology, University Heart Center, Zurich, Switzerland
  2. Division of Cardiology, GZO – Regional Health Center, Wetzikon, Switzerland
  3. Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland
  4. Center for Integrative Human Physiology, University of Zurich, Switzerland

open access

Ahead of print
Original articles
Submitted: 2021-06-20
Accepted: 2022-05-23
Published online: 2022-12-07

Abstract

Background: Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na+ current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are scarce.

Methods: Patients with AF who received chronic flecainide or propafenone therapy were retrospectively studied from the database of a tertiary care center. The primary outcome of the study was clinical efficacy of Class Ic antiarrhythmics, which was assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up.

Results: Among the 361 patients (261 males, 72.3%) with a mean age of 56 ± 12 years, 287 (79.5%) were using long-term flecainide, and 74 (20.5%) patients propafenone. The majority of the patients had paroxysmal AF (n = 331, 91.7%) and had an atrioventricular-nodal blocking co-medication (n = 287, 79.5%). A total of 117 (32%) patients discontinued therapy after a median of 210 days (interquartile range 62–855 days). Clinical efficacy was observed in 188 patients (52%). The most common reason for therapy discontinuation was adverse drug effects, particularly proarrhythmic effects (48% for flecainide and 33% for propafenone). Patients who did not clinically benefit from Class Ic antiarrhythmics more often underwent pulmonary vein isolation (p = 0.02).

Conclusions: Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in approximately half of the patients with paroxysmal or persistent AF. However, these drugs were also associated with a relatively high rate of adverse events, and in particular proarrhythmic effects, which often resulted in therapy discontinuation rendering appropriate patient selection and therapy surveillance essential.

Abstract

Background: Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na+ current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are scarce.

Methods: Patients with AF who received chronic flecainide or propafenone therapy were retrospectively studied from the database of a tertiary care center. The primary outcome of the study was clinical efficacy of Class Ic antiarrhythmics, which was assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up.

Results: Among the 361 patients (261 males, 72.3%) with a mean age of 56 ± 12 years, 287 (79.5%) were using long-term flecainide, and 74 (20.5%) patients propafenone. The majority of the patients had paroxysmal AF (n = 331, 91.7%) and had an atrioventricular-nodal blocking co-medication (n = 287, 79.5%). A total of 117 (32%) patients discontinued therapy after a median of 210 days (interquartile range 62–855 days). Clinical efficacy was observed in 188 patients (52%). The most common reason for therapy discontinuation was adverse drug effects, particularly proarrhythmic effects (48% for flecainide and 33% for propafenone). Patients who did not clinically benefit from Class Ic antiarrhythmics more often underwent pulmonary vein isolation (p = 0.02).

Conclusions: Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in approximately half of the patients with paroxysmal or persistent AF. However, these drugs were also associated with a relatively high rate of adverse events, and in particular proarrhythmic effects, which often resulted in therapy discontinuation rendering appropriate patient selection and therapy surveillance essential.

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Keywords

flecainide, propafenone, antiarrhythmics, atrial fibrillation, clinical outcome

About this article
Title

Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2022-12-07

Page views

270

Article views/downloads

146

DOI

10.5603/CJ.a2022.0116

Pubmed

36510792

Keywords

flecainide
propafenone
antiarrhythmics
atrial fibrillation
clinical outcome

Authors

Boldizsar Kovacs
Haci Yakup Yakupoglu
Urs Eriksson
Nazmi Krasniqi
Firat Duru

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