In patients with new-onset atrial fibrillation post-PCI, Class Ic antiarrhythmic drugs were associated with a lower risk of MACE compared to non-use (asHR 0.64; 95% CI 0.59-0.68; p<0.01).
Cohort (n=3,750)
Yes
Does Class Ic antiarrhythmic therapy reduce major adverse cardiovascular events in adults with new-onset atrial fibrillation after PCI?
In patients with chronic coronary syndrome and new-onset atrial fibrillation post-PCI, Class Ic antiarrhythmic drugs were associated with lower risks of MACE and mortality without increasing ventricular arrhythmias.
Effect estimate: asHR 0.64 (95% CI 0.59-0.68)
p-value: p=< 0.01
BACKGROUND Class Ic antiarrhythmic drugs are generally avoided in patients with coronary artery disease (CAD) due to concerns about their proarrhythmic potential. However, their impact on mortality and arrhythmic risk in patients with chronic coronary syndrome (CCS) who have undergone percutaneous coronary intervention (PCI) remains unclear. OBJECTIVE To assess the safety of Class Ic antiarrhythmic drugs compared to non-use in patients with new-onset atrial fibrillation (NOAF) after PCI. METHODS A retrospective cohort study using Taiwan's NHIRD included adults with NOAF post-PCI. Participants were divided into Class Ic users and non-users. Outcomes evaluated included major adverse cardiovascular events (MACE), all-cause mortality, ventricular arrhythmia, and cerebrovascular events. Cox models and competing risk analyses estimated hazard ratios. RESULTS Among 3,750 patients (mean age 74.70, 69.33% male, CHA2DS2-VASc score 3.98), Class Ic users showed significantly lower risks of MACE (asHR, 0.64; 95% CI, 0.59-0.68; p < 0.01), all-cause mortality (aHR 0.61; 95% CI, 0.57-0.66; p < 0.01), and cerebrovascular events(asHR 0.81; 95% CI, 0.66-0.99; p =0.04). No increased risk of ventricular arrhythmia was observed (asHR 0.89; 95% CI, 0.69-1.15; p =0.37). CONCLUSION In patients with CCS who developed NOAF, the use of Class Ic antiarrhythmic drugs was associated with significantly lower risks of major adverse cardiovascular events, all-cause mortality, cerebrovascular events, and without an increased risk of ventricular arrhythmia. These findings suggest that Class Ic agents may be a safe and effective option for rhythm control in carefully selected CCS patients.
Huang et al. (Sun,) conducted a cohort in New-onset atrial fibrillation after PCI (n=3,750). Class Ic antiarrhythmic drugs vs. Non-use was evaluated on Major adverse cardiovascular events (MACE) (asHR 0.64, 95% CI 0.59-0.68, p=< 0.01). In patients with new-onset atrial fibrillation post-PCI, Class Ic antiarrhythmic drugs were associated with a lower risk of MACE compared to non-use (asHR 0.64; 95% CI 0.59-0.68; p<0.01).