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Long-term adherence to flecainide as a rhythm control therapy in recurrent atrial fibrillation – a retrospective cohort study

Siotis, Alexander LU orcid ; Johansson, Samuel ; Graff, Claus ; Madsen Härdig, Bjarne LU orcid and Platonov, Pyotr LU (2025) In Scandinavian Cardiovascular Journal 59(1). p.1-10
Abstract
Background. Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. Objective. To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. Methods. Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included (n = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right... (More)
Background. Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. Objective. To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. Methods. Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included (n = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right ventricular fractional area change (RV-FAC) were assessed. The primary endpoint was flecainide discontinuation for any reason. Secondary endpoints were discontinuation due to rhythm control failure and rhythm-related adverse events. Results. After hospital discharge, 120 patients were followed for a median of 1.5 years (interquartile range 0.34–3.1). During follow-up 31% discontinued flecainide, 14% due to rhythm control failure and 10% due to rhythm-related adverse events. Flecainide discontinuation was associated with PWD ≥130 ms (HR 3.65, [1.36–9.75]), DTNP-V1 > 0.1 mV (HR 3.78, [1.15–12.4]), LAVI >48 ml/m2 (HR 4.43, [2.02–9.70]), moderate mitral regurgitation (HR 4.40, [1.57–12.4]), and RV-FAC <35% (HR 2.30, [1.03–5.16]). Rhythm control failure was associated with PWD, DTNP-V1, LAVI and moderate mitral regurgitation. Rhythm-related adverse events were associated with RV-FAC, LAVI and moderate mitral regurgitation. Conclusion. ECG and echocardiographic indices were associated with discontinuation of flecainide, including safety and efficacy outcomes in long-term treated patients with AF. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Cardiovascular Journal
volume
59
issue
1
pages
1 - 10
publisher
Taylor & Francis
external identifiers
  • pmid:40553490
ISSN
1651-2006
DOI
10.1080/14017431.2025.2525110
project
Medical treatment with Tambocor in atrial fibrillation, can we optimize the treatment?
Helsingborg Resuscitation and Cardiovascular Research Group
language
English
LU publication?
yes
id
1cd7057f-97cd-45e2-bc12-16b905e60545
date added to LUP
2025-06-26 20:15:59
date last changed
2025-06-27 08:02:10
@article{1cd7057f-97cd-45e2-bc12-16b905e60545,
  abstract     = {{Background. Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. Objective. To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. Methods. Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included (n = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right ventricular fractional area change (RV-FAC) were assessed. The primary endpoint was flecainide discontinuation for any reason. Secondary endpoints were discontinuation due to rhythm control failure and rhythm-related adverse events. Results. After hospital discharge, 120 patients were followed for a median of 1.5 years (interquartile range 0.34–3.1). During follow-up 31% discontinued flecainide, 14% due to rhythm control failure and 10% due to rhythm-related adverse events. Flecainide discontinuation was associated with PWD ≥130 ms (HR 3.65, [1.36–9.75]), DTNP-V1 &gt; 0.1 mV (HR 3.78, [1.15–12.4]), LAVI &gt;48 ml/m2 (HR 4.43, [2.02–9.70]), moderate mitral regurgitation (HR 4.40, [1.57–12.4]), and RV-FAC &lt;35% (HR 2.30, [1.03–5.16]). Rhythm control failure was associated with PWD, DTNP-V1, LAVI and moderate mitral regurgitation. Rhythm-related adverse events were associated with RV-FAC, LAVI and moderate mitral regurgitation. Conclusion. ECG and echocardiographic indices were associated with discontinuation of flecainide, including safety and efficacy outcomes in long-term treated patients with AF.}},
  author       = {{Siotis, Alexander and Johansson, Samuel and Graff, Claus and Madsen Härdig, Bjarne and Platonov, Pyotr}},
  issn         = {{1651-2006}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{1}},
  pages        = {{1--10}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Cardiovascular Journal}},
  title        = {{Long-term adherence to flecainide as a rhythm control therapy in recurrent atrial fibrillation – a retrospective cohort study}},
  url          = {{https://lup.lub.lu.se/search/files/222200072/Long-term_adherence_to_flecainide_as_a_rhythm_control_therapy_in_recurrent_atrial_fibrillation_a_retrospective_cohort_study-1.pdf}},
  doi          = {{10.1080/14017431.2025.2525110}},
  volume       = {{59}},
  year         = {{2025}},
}