Key result
Flecainide effectively treats idiopathic ventricular arrhythmias and shows safety in selected non-ischemic heart disease.
Why the study?
Recent studies have demonstrated good effectiveness and safety of flecainide across different structural heart diseases, prompting a reassessment of evidence 30 years after CAST data.
Does flecainide safely and effectively treat ventricular arrhythmias in patients with and without structural heart disease?
Does flecainide safely and effectively treat ventricular arrhythmias in patients with and without structural heart disease?
This review calls for a re-evaluation of the historical contraindication to flecainide in structural heart disease, suggesting potential safety and efficacy in non-ischemic cardiomyopathies when guided by modern diagnostic tools like CMR.
Calls for re-evaluation of flecainide contraindications in structural heart disease; leaves open adoption pending randomized confirmation.
Flecainide is an IC antiarrhythmic drug (AAD) that received in 1984 Food and Drug Administration approval for the treatment of sustained ventricular tachycardia (VT) and subsequently for rhythm control of atrial fibrillation (AF). Currently, flecainide is mainly employed for sinus rhythm maintenance in AF and the treatment of idiopathic ventricular arrhythmias (IVA) in absence of ischaemic and structural heart disease on the basis of CAST data. Recent studies enrolling patients with different structural heart diseases demonstrated good effectiveness and safety profile of flecainide. The purpose of this review is to assess current evidence for appropriate and safe use of flecainide, 30 years after CAST data, in the light of new diagnostic and therapeutic tools in the field of ischaemic and non-ischaemic heart disease.
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Lavalle et al. (2021) conducted a review in Ventricular Arrhythmias. Flecainide was evaluated. Flecainide is effective for idiopathic ventricular arrhythmias, and recent studies suggest it may also be safe in selected patients with non-ischemic structural heart disease.
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