Background

Flecainide is a class IC antiarrhythmic drug that is contraindicated in patients who have a history of myocardial infarction, but its effect on mortality and risk of proarrhythmia in patients with stable obstructive and nonobstructive epicardial coronary artery disease (CAD) has not been assessed.

Objective

We sought to compare the safety of flecainide administration in patients who had angiographic evidence of either no or minimal CAD versus nonobstructive CAD, and those who underwent nuclear stress testing with perfusion defects versus those without perfusion defects.

Methods

We conducted a retrospective chart review of 348 patients who were treated with flecainide for at least 1 year duration and underwent evaluation for CAD with coronary angiography or myocardial perfusion imaging (MPI) stress testing within 3 months of initiating flecainide. We compared overall mortality and proarrhythmia between varying levels of CAD and perfusion defects.

Results

There was a similar 10-year survival between those with no or minimal CAD, nonobstructive CAD, and obstructive CAD (p = 0.6). Additionally, there was no difference in arrhythmia burden, including sustained ventricular tachycardias or frequent premature ventricular contractions (> 5% daily burden; p = 0.25). There was also no increase in mortality among those who had reversible perfusion defects >0% compared with those without, among subjects who underwent MPI (p = 0.14). On subgroup analysis, there was no increased risk in all-cause mortality with any specific coronary artery involvement, or with obstructive multivessel CAD (p = 0.89).

Conclusion

Flecainide use is not associated with an increase in either all-cause mortality or ventricular arrhythmias in low-risk patients with stable nonobstructive CAD.

中文翻译：

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氟卡尼在稳定型冠状动脉疾病中的应用：其在非阻塞性和阻塞性冠状动脉疾病中的安全性分析

背景

氟卡尼是 IC 类抗心律失常药物，禁用于有心肌梗死病史的患者，但尚未评估其对稳定阻塞性和非阻塞性心外膜冠状动脉疾病 (CAD) 患者死亡率和致心律失常风险的影响。

客观的

我们试图比较在血管造影证据显示无 CAD 或轻微 CAD 与非阻塞性 CAD 的患者中，以及接受有灌注缺陷的核压力测试的患者与无灌注缺陷的患者中氟卡尼给药的安全性。

方法

我们对 348 名接受氟卡尼治疗至少 1 年的患者进行了回顾性图表审查，并在开始使用氟卡尼的 3 个月内通过冠状动脉造影或心肌灌注成像 (MPI) 压力测试评估了 CAD。我们比较了不同程度的 CAD 和灌注缺陷之间的总体死亡率和致心律失常。

结果

无或极少 CAD、非阻塞性 CAD 和阻塞性 CAD 的 10 年生存率相似 ( p  = 0.6)。此外，心律失常负荷没有差异，包括持续性室性心动过速或频繁室性早搏（> 5% 每日负荷；p  = 0.25）。在接受 MPI 的受试者中，与没有可逆性灌注缺损的患者相比，可逆性灌注缺损 >0% 的患者死亡率也没有增加（p  = 0.14）。在亚组分析中，任何特定冠状动脉受累或阻塞性多支血管 CAD 的全因死亡率没有增加 ( p  = 0.89)。

结论

在患有稳定型非阻塞性 CAD 的低风险患者中，氟卡尼的使用与全因死亡率或室性心律失常的增加无关。