The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events
Article first published online: 2 JUN 2011
© 2011 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 270, Issue 3, pages 281–290, September 2011
How to Cite
Almroth, H., Andersson, T., Fengsrud, E., Friberg, L., Linde, P., Rosenqvist, M. and Englund, A. (2011), The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events. Journal of Internal Medicine, 270: 281–290. doi: 10.1111/j.1365-2796.2011.02395.x
- Issue published online: 11 AUG 2011
- Article first published online: 2 JUN 2011
- atrial fibrillation;
- sudden cardiac death
Abstract. Almroth H, Andersson T, Fengsrud E, Friberg L, Linde P, Rosenqvist M, Englund A (Örebro University Hospital, Örebro; Danderyd Hospital and Karolinska Institutet at Danderyd Hospital, Stockholm; and Karolinska Institutet at Stockholm South Hospital, Sweden). The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events. J Intern Med 2011; 270: 281–290.
Objective. To assess the safety of long-term treatment with flecainide in patients with atrial fibrillation (AF), particularly with regard to sudden cardiac death (SCD) and proarrhythmic events.
Design. Retrospective, observational cohort study.
Setting. Single-centre study at Örebro University Hospital, Sweden.
Subjects. A total of 112 patients with paroxysmal (51%) or persistent (49%) AF (mean age 60 ± 11 years) were included after identifying all patients with AF who initiated oral flecainide treatment (mean dose 203 ± 43 mg per day) between 1998 and 2006. Standard exclusion/inclusion criteria for flecainide were used, and flecainide treatment was usually combined with an atrioventricular-blocking agent (89%).
Main outcome measure. Death was classified as sudden or nonsudden according to standard definitions. Proarrhythmia was defined as cardiac syncope or life-threatening arrhythmia.
Results. Eight deaths were reported during a mean follow-up of 3.4 ± 2.4 years. Compared to the general population, the standardized mortality ratios were 1.57 (95% confidence interval (CI) 0.68–3.09) for all-cause mortality and 4.16 (95% CI 1.53–9.06) for death from cardiovascular disease. Three deaths were classified as SCDs. Proarrhythmic events occurred in six patients (two each with wide QRS tachycardia, 1 : 1 conducted atrial flutter and syncope during exercise).
Conclusion. We found an increased incidence of SCD or proarrhythmic events in this real-world study of flecainide used for the treatment of AF. The findings suggest that further investigation into the safety of flecainide for the treatment of patients with AF is warranted.