Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting
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Key result
Long-term Class Ic antiarrhythmics show clinical efficacy in ~52% of AF patients despite frequent proarrhythmic discontinuation.
- n=361
Why the study?
Data on the long-term clinical efficacy and safety of flecainide and propafenone for rhythm control in atrial fibrillation in a real-world setting are scarce.
Does long-term therapy with flecainide or propafenone improve arrhythmia-related symptoms in patients with atrial fibrillation?
Population
361 AF patients receiving chronic flecainide or propafenone at a tertiary care center
Comparison
Flecainide vs propafenone therapy
Design
Retrospective cohort study
Authors
Discussion
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Implication
Modest long-term symptom control with frequent proarrhythmic discontinuations supports cautious use and close surveillance in selected AF patients; leaves open need for prospective comparative trials.
Study Design
Type
Observational (n=361)
Multicenter
No
Structured PICO
Does long-term therapy with flecainide or propafenone improve arrhythmia-related symptoms in patients with atrial fibrillation?
P
Population
361 patients (mean age 56 years, 27.7% female) with symptomatic atrial fibrillation treated with flecainide or propafenone, followed for a median of 198 days.
E
Exposure
Long-term therapy with Class Ic antiarrhythmics (flecainide [n=287] or propafenone [n=74]).
O
Outcome
Clinical efficacy, assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up.patient reported
Long-term Class Ic antiarrhythmic therapy provides symptom improvement in about half of AF patients but is limited by a high rate of adverse events, particularly proarrhythmia, necessitating careful patient selection.
Limitations
- Retrospective design without predefined follow-up evaluations
- Lack of data on further co-morbidities
- Loss of follow-up making mortality estimation impossible
- Lack of a control group to exclude potential confounders
Cite This Study
Kovacs et al. (2022) conducted an observational in Atrial fibrillation (n=361). Class Ic antiarrhythmics (flecainide or propafenone) was evaluated on Clinical efficacy (improvement of arrhythmia-related symptoms at last follow-up). Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in 52.1% of patients with atrial fibrillation, though 32% discontinued therapy primarily due to adverse proarrhythmic effects.
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