Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO02 - Poster Session II (ID 47) Poster

D-PO02-228 - The Feasibility And Safety Of Flecainide Use Among Patients With Coronary Disease In The Absence Of Acute Or Non-revascularized Myocardial Infarction (ID 1070)


Background: Flecainide is a well-tolerated and effective drug for atrial tachyarrhythmias. However, its use is restricted in patients with structural heart disease, including patients with CAD. This approach is largely based on clinical trial data from patients with recent MI and heart failure, and for treatment of ventricular arrhythmias. Data on the safety and feasibility of the use of flecainide in patients with CAD in the absence of recent acute coronary syndromes are lacking.
Objective: To evaluate the safety and feasibility of treatment with flecainide in patients with varying degrees of CAD (without non-revascularized MI) in a serial, real-world cohort.
Methods: We retrospectively identified all patients being treated with antiarrhythmic drugs at our intuition from November 2006 to September 2019. We excluded those with a prior history of VT, ICD placement, or non-revascularized MI. We then identified all patients on flecainide (n=2836), and those on sotalol (n=2763) to serve as controls. Baseline clinical characteristics including degree of CAD (categorized as: none, non-obstructive, or obstructive), other comorbid illness, and medication use. Clinical outcomes, including survival, were also ascertained. We performed Cox regression analysis to evaluate the effect of flecainide on mortality across varying degrees of CAD on survival.
Results: We identified a total cohort of 5599 patients. After adjusting for numerous baseline characteristics, there was no independent association between flecainide use and mortality. Similarly, there was no significant interaction between flecainide use and mortality (compared sotalol) among patients with non-obstructive CAD (OR 1.55, 95% CI: 095-2.52, p=0.077). However, there was a significant interaction among those with obstructive coronary disease (OR 2.90, 95% CI: 1,70-4.83, p<0.001).
Conclusion: Among select patients with non-obstructive CAD and without a history of VT, flecainide is not associated with increased mortality. However, the use of flecainide in obstructive CAD is associated with poorer survival. Given these findings, flecainide may be an option to some patients in whom it is frequently restricted. Further prospective studies are warranted.