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Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting

BACKGROUND: Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na(+) current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are sca...

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Autores principales: Kovacs, Boldizsar, Yakupoglu, Haci Yakup, Eriksson, Urs, Krasniqi, Nazmi, Duru, Firat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Via Medica 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987554/
https://www.ncbi.nlm.nih.gov/pubmed/36510792
http://dx.doi.org/10.5603/CJ.a2022.0116
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author Kovacs, Boldizsar
Yakupoglu, Haci Yakup
Eriksson, Urs
Krasniqi, Nazmi
Duru, Firat
author_facet Kovacs, Boldizsar
Yakupoglu, Haci Yakup
Eriksson, Urs
Krasniqi, Nazmi
Duru, Firat
author_sort Kovacs, Boldizsar
collection PubMed
description BACKGROUND: Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na(+) current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are scarce. METHODS: Patients with AF who received chronic flecainide or propafenone therapy were retrospectively studied from the database of a tertiary care center. The primary outcome of the study was clinical efficacy of Class Ic antiarrhythmics, which was assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up. RESULTS: Among the 361 patients (261 males, 72.3%) with a mean age of 56 ± 12 years, 287 (79.5%) were using long-term flecainide, and 74 (20.5%) patients propafenone. The majority of the patients had paroxysmal AF (n = 331, 91.7%) and had an atrioventricular-nodal blocking co-medication (n = 287, 79.5%). A total of 117 (32%) patients discontinued therapy after a median of 210 days (interquartile range 62–855 days). Clinical efficacy was observed in 188 (52%) patients. The most common reason for therapy discontinuation was adverse drug effects, particularly proarrhythmic effects (48% for flecainide and 33% for propafenone). Patients who did not clinically benefit from Class Ic antiarrhythmics more often underwent pulmonary vein isolation (p = 0.02). CONCLUSIONS: Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in approximately half of the patients with paroxysmal or persistent AF. However, these drugs were also associated with a relatively high rate of adverse events, and in particular proarrhythmic effects, which often resulted in therapy discontinuation rendering appropriate patient selection and therapy surveillance essential.
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spelling pubmed-99875542023-03-07 Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting Kovacs, Boldizsar Yakupoglu, Haci Yakup Eriksson, Urs Krasniqi, Nazmi Duru, Firat Cardiol J Clinical Cardiology BACKGROUND: Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na(+) current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are scarce. METHODS: Patients with AF who received chronic flecainide or propafenone therapy were retrospectively studied from the database of a tertiary care center. The primary outcome of the study was clinical efficacy of Class Ic antiarrhythmics, which was assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up. RESULTS: Among the 361 patients (261 males, 72.3%) with a mean age of 56 ± 12 years, 287 (79.5%) were using long-term flecainide, and 74 (20.5%) patients propafenone. The majority of the patients had paroxysmal AF (n = 331, 91.7%) and had an atrioventricular-nodal blocking co-medication (n = 287, 79.5%). A total of 117 (32%) patients discontinued therapy after a median of 210 days (interquartile range 62–855 days). Clinical efficacy was observed in 188 (52%) patients. The most common reason for therapy discontinuation was adverse drug effects, particularly proarrhythmic effects (48% for flecainide and 33% for propafenone). Patients who did not clinically benefit from Class Ic antiarrhythmics more often underwent pulmonary vein isolation (p = 0.02). CONCLUSIONS: Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in approximately half of the patients with paroxysmal or persistent AF. However, these drugs were also associated with a relatively high rate of adverse events, and in particular proarrhythmic effects, which often resulted in therapy discontinuation rendering appropriate patient selection and therapy surveillance essential. Via Medica 2023-02-27 /pmc/articles/PMC9987554/ /pubmed/36510792 http://dx.doi.org/10.5603/CJ.a2022.0116 Text en Copyright © 2023 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
spellingShingle Clinical Cardiology
Kovacs, Boldizsar
Yakupoglu, Haci Yakup
Eriksson, Urs
Krasniqi, Nazmi
Duru, Firat
Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
title Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
title_full Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
title_fullStr Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
title_full_unstemmed Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
title_short Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
title_sort medical therapy with flecainide and propafenone in atrial fibrillation: long-term clinical experience in the tertiary care setting
topic Clinical Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987554/
https://www.ncbi.nlm.nih.gov/pubmed/36510792
http://dx.doi.org/10.5603/CJ.a2022.0116
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