Abstract 15345: Long-Term Outcomes in Patients Treated With Flecainide for Atrial Fibrillation With Severe Coronary Artery Disease Treated With Revascularization

BackgroundThe presence of coronary artery disease (CAD) is viewed as a contraindication to use class 1c antiarrhythmic drugs (AAD) due to risk of proarrhythmia, heart failure (HF), and morality. Successful revascularization treats ischemia and in the absence of prior myocardial infarction (MI) may lower the prior risk observed in patients treated with class 1c AADs and severe CAD. Due to concern of risk, long-term data are lacking regarding the use of these medications for atrial fibrillation (AF) or other arrhythmias in patients post revascularization.MethodsFrom a population of 28,129 patients treated with initiation of AADs for primarily AF, two patient populations were created status post revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) based upon AAD class (class III AAD=1,603 and flecainide=150). Patients with an MI, unstable angina, or HF hospitalization within the previous year were excluded. Mortality, HF, ventricular tachycardia (VT), and MACE were assessed at 3 years.ResultsThe two CAD with revascularization populations treated either with class III AAD and flecainide therapy were similar for age (74.9±9.2 vs 75.5±8.1), male gender (75% versus 70%), hypertension (96% vs 96%), diabetes (46% versus 40%), and ejection fraction (55±14 vs 56±12). In the class III AAD group the most commonly used drugs were amiodarone (64%) and sotalol (25%). At 3 years, mortality and MACE rates were higher in the class III AAD group and HF and VT rates were similar (Figure). Multivariable adjustment for risk with flecainide compared to class IIIc AADs showed a nonsignificant reduction in all endpoints [Hazard ratio0.85 (death), 0.89 (HF), 0.72 (VT), and 0.90 (MACE)].ConclusionsFlecainide in patients with severe CAD treated by revascularization with a preserved ejection fraction was associated with favorable risks of death, HF, and proarrhythmia (VT) compared to class IIIc alternatives.