BACKGROUND Class 1C antiarrhythmic drugs (AAD) have been associated with harm in patients treated for ventricular arrhythmias with a prior myocardial infarction. Consensus guidelines have advocated that these drugs not be used in patients with stable coronary artery disease (CAD). However, long-term data are lacking to know if unique risks exist when these drugs are used for atrial fibrillation (AF) in patients with CAD without a prior myocardial infarction. METHODS In 24,315 patients treated with the initiation of AADs, two populations were evaluated: (1) propensity-matched AF patients with CAD were created based upon AAD class (flecainide, n = 1,114, vs class-3 AAD, n = 1,114) and (2) AF patients who had undergone a percutaneous coronary intervention or coronary artery bypass graft (flecainide, n = 150, and class-3 AAD, n = 1,453). Outcomes at 3 years for mortality, heart failure (HF) hospitalization, ventricular tachycardia (VT), and MACE were compared between the groups. RESULTS At 3 years, mortality (9.1% vs 19.3%, P < .0001), HF hospitalization (12.5% vs 18.3%, P < .0001), MACE (22.9% vs 36.6%, P < .0001), and VT (5.8% vs 8.5%, P = .02) rates were significantly lower in the flecainide group for population 1. In population 2, adverse event rates were also lower, although not significantly, in the flecainide compared to the class-3 AAD group for mortality (20.9% vs 25.8%, P = .26), HF hospitalization (24.5% vs 26.1%, P = .73), VT (10.9% vs 14.7%, P = .28) and MACE (44.5% vs 49.5%, P = .32). CONCLUSIONS Flecainide in select patients with stable CAD for AF has a favorable safety profile compared to class-3 AADs. These data suggest the need for prospective trials of flecainide in AF patients with CAD to determine if the current guideline-recommended exclusion is warranted.

中文翻译：

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用氟卡尼治疗房颤合并稳定型冠状动脉疾病患者的长期结果。

背景 1C 类抗心律失常药物 (AAD) 与既往有心肌梗塞的室性心律失常治疗患者的伤害有关。共识指南主张这些药物不用于稳定型冠状动脉疾病 (CAD) 患者。然而，长期数据尚不清楚当这些药物用于没有既往心肌梗塞的 CAD 患者的心房颤动 (AF) 时是否存在独特的风险。方法 在接受 AAD 治疗的 24,315 名患者中，对两个人群进行了评估：（1）根据 AAD 类别（氟卡尼，n = 1,114 与 3 级 AAD，n = 1,114）创建倾向匹配的伴有 CAD 的 AF 患者和(2) 接受过经皮冠状动脉介入治疗或冠状动脉旁路移植术的 AF 患者（氟卡尼，n = 150，和 3 级 AAD，n = 1,453）。比较两组间的死亡率、心力衰竭 (HF) 住院、室性心动过速 (VT) 和 MACE 的 3 年结果。结果 3 年时，死亡率（9.1% 对 19.3%，P < .0001）、HF 住院（12.5% 对 18.3%，P < .0001）、MACE（22.9% 对 36.6%，P < .0001）和 VT (5.8% vs 8.5%, P = .02) 人群 1 的氟卡尼组发生率显着降低。在人群 2 中，与 3 类 AAD 组相比，氟卡尼组的不良事件发生率也较低，尽管不显着死亡率 (20.9% vs 25.8%, P = .26)、HF 住院 (24.5% vs 26.1%, P = .73)、VT (10.9% vs 14.7%, P = .28) 和 MACE (44.5% vs 49.5 %，P = .32）。结论 与 3 类 AAD 相比，氟卡尼用于 AF 稳定型 CAD 患者的安全性较好。