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The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-2654-9427
Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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2011 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 270, no 3, p. 281-290Article in journal (Refereed) Published
Abstract [en]

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) andproarrhythmic events.

Design: Retrospective,observational cohort study.Setting.Single-centre study at Örebro University Hospital, Sweden.

Setting: Single-centre study at Orebro 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,andflecainidetreatmentwasusually combined withanatrioventricular-blocking agent (89%).

Main outcome measure: Death was classified as sudden or nonsudden according to standard definitions. Proarrhythmia was defined as cardiac syncope or lifethreatening arrhythmia.

Results: Eight deaths were reported during a mean follow- up of 3.4 ± .4 years. Compared to the general population, the standardized mortality ratios were 1.57 (95% confidence interval (CI) 0.68–3.09) for allcause 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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2011. Vol. 270, no 3, p. 281-290
Keywords [en]
atrial fibrillation, flecainide, proarrhythmia, safety, sudden cardiac death
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-22942DOI: 10.1111/j.1365-2796.2011.02395.xISI: 000293793600011PubMedID: 21635583Scopus ID: 2-s2.0-80051576394OAI: oai:DiVA.org:oru-22942DiVA, id: diva2:527994
Note

Funding Agencies:

Boehringer-Ingelheim  

Sanofi-Aventis  

Astra Zeneca  

Bristol-Myers Squibb 

Available from: 2012-05-23 Created: 2012-05-23 Last updated: 2018-09-11Bibliographically approved
In thesis
1. Atrial fibrillation: inflammatory and pharmacological studies
Open this publication in new window or tab >>Atrial fibrillation: inflammatory and pharmacological studies
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 75
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 70
Keywords
Atrial fibrillation, inflammation, randomised, sudden cardiac
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-22590 (URN)978-91-7668-875-5 (ISBN)
Public defence
2012-06-15, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
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Supervisors
Available from: 2012-04-19 Created: 2012-04-19 Last updated: 2017-10-17Bibliographically approved

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Almroth, HenrikAndersson, TorbjornFengsrud, Espen

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