Conference Proceeding - Restricted Access
Journal of the American College of Cardiology
Background: Flecainide and Propafenone (1C-AADs) are effective in achieving rhythm control in patients with atrial fibrillation (afib) and suppressing premature ventricular contractions (PVCs). In patients with ischemic structural heart disease, 1C-AADs have been shown to increase mortality and pro-arrhythmic events. Based on this trial, the use of 1C-AADs in patients with non-ischemic cardiomyopathy (NICM) is not endorsed by current guidelines. Methods: The purpose of this study was to investigate the real-world utilization and safety of 1C-AADs in patients with NICM. Results: A total of 210 patients were identified who had a diagnosis of NICM and were treated with 1C-AADs. The average age was 71 (SD 11 years). There were 134 (63.1%) males . 86 (41%) patients were treated with flecainide and 124 (59%) with propafenone. The average duration of treatment was 4.34 years (standard deviation of 1.97). 194 (92.4%) of studied patients were being treated for afib while the rest had Class IC for PVC suppression. At least 1 prior failed ablation was recorded in 43 (20.5%). At least 1 treatment failure with a class 3 antiarrhythmic medication prior to therapy with 1C-AADs was identified in 56 (26.7%). 30 (14.28%) patients had an implantable cardioverter-defibrillator (ICD). Nine patients (4.29%) had at least 1 episode of NSVT while being treated with 1C-AADs . There were no patients who experienced sustained VT while being treated. There were no patients who experienced cardiac death while being treated. There were 5 (2.3%) deaths while receiving therapy; all of which cause of death was adjudicated as not related to antiarrhythmic therapy. Secondary outcomes included change in ejection fraction (EF) and change in PVC burden. The mean EF before treatment was 56.53% and after treatment was 53.48% (P=0.002) The mean PVC burden decreased by 1.08% (P=0.604). Conclusion: In 210 patients with NICM who were treated with 1C-AADs there were no episodes of sustained VT and no cardiac related deaths.
Sherman A, Tawney A, Mehta N. Flecainide and propafenone safety in patients with non-ischemic cardiomyopathy. J Am Coll Cardiol. 2022 Mar 8;79(9 Suppl):128.