The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events
Journal of Internal Medicine, 08/17/2011
Almroth H et al. – The authors found an increased incidence of SCD or proarrhythmic events in this real–world study of flecainide used for the treatment of atrial fibrillation (AF). The findings suggest that further investigation into the safety of flecainide for the treatment of patients with AF is warranted.Methods
- Retrospective, observational cohort study.
- Single–centre study at Örebro University Hospital, Sweden.
- A total of 112 patients with paroxysmal (51%) or persistent (49%) AF (mean age 60 ± 11 years) were included after identifying all patients with AF who initiated oral flecainide treatment (mean dose 203 ± 43 mg per day) between 1998 and 2006.
- Standard exclusion/inclusion criteria for flecainide were used, and flecainide treatment was usually combined with an atrioventricular–blocking agent (89%).
- Death was classified as sudden or nonsudden according to standard definitions.
- Proarrhythmia was defined as cardiac syncope or life–threatening arrhythmia.
- Eight deaths were reported during a mean follow–up of 3.4 ± 2.4 years.
- Compared to the general population, the standardized mortality ratios were 1.57 (95% confidence interval (CI) 0.68–3.09) for all–cause mortality and 4.16 (95% CI 1.53–9.06) for death from cardiovascular disease.
- Three deaths were classified as SCDs.
- Proarrhythmic events occurred in six patients (two each with wide QRS tachycardia, 1 : 1 conducted atrial flutter and syncope during exercise).