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Use of Flecainide in Stable Coronary Artery Disease: An Analysis of Its Safety in Both Nonobstructive and Obstructive Coronary Artery Disease

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Abstract

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.

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Acknowledgements

The authors acknowledge the assistance of Skye Buckner-Petty and Katrina Devick, who provided statistical assistance for this project.

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Correspondence to Hasan Ashraf.

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Funding

This work was supported by the Mayo Clinic Department of Cardiovascular Diseases, which provided internal funding for this work.

Conflict of interest

Hasan Ashraf, Nway Ko Ko, Vatsal Ladia, Pradyumna Agasthi, Tadhg Prendiville, Fergus O’Herlihy, Sai Harika Pujari, Siva K. Mulpuru, Luis Scott, and Dan Sorajja declare they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Ashraf, H., Ko, N.K., Ladia, V. et al. Use of Flecainide in Stable Coronary Artery Disease: An Analysis of Its Safety in Both Nonobstructive and Obstructive Coronary Artery Disease. Am J Cardiovasc Drugs 21, 563–572 (2021). https://doi.org/10.1007/s40256-021-00483-9

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