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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 ; Madsen Hardig, Bjarne LU ; Johansson, Samuel ; Carlson, Jonas LU orcid ; Wagner, Henrik LU and Platonov, P.G. LU (2022) In Heart Rhythm 19(5). p.315-316
Abstract
Background: The choice of rhythm control drugs for recurrent atrial fibrillation (AF) remains empirical and is based on the safety profile rather than predicted efficacy. Flecainide is recommended for prevention of AF recurrence in patients without structural heart disease however predictors of treatment success are insufficiently studied. Objective: To assess clinical characteristics associated with flecainide treatment success in patients with recurrent AF. Methods: Using hospital medical records, 135 consecutive adult AF patients who were referred for in-hospital initiation of flecainide were included (median age 62 (IQR 53-70) years, 35% females, 28% persistent AF, median CHA2DS2-VASc score 1, median follow up time 14.5 (IQR 3.3-32.7)... (More)
Background: The choice of rhythm control drugs for recurrent atrial fibrillation (AF) remains empirical and is based on the safety profile rather than predicted efficacy. Flecainide is recommended for prevention of AF recurrence in patients without structural heart disease however predictors of treatment success are insufficiently studied. Objective: To assess clinical characteristics associated with flecainide treatment success in patients with recurrent AF. Methods: Using hospital medical records, 135 consecutive adult AF patients who were referred for in-hospital initiation of flecainide were included (median age 62 (IQR 53-70) years, 35% females, 28% persistent AF, median CHA2DS2-VASc score 1, median follow up time 14.5 (IQR 3.3-32.7) months). Patient characteristics at admission, including left atrial enlargement (LAE) assessed as LA volume index >34 ml/m2, were retrieved from medical records. Kaplan Meier curve and Cox regression analysis were used to analyse the association between the clinical characteristics and the likelihood of the drug discontinuation due to failed rhythm control efficacy (primary endpoint) or discontinuation for any reason (secondary endpoint). Results: By the end of follow up 88 patients (65.0%) had continued flecainide therapy. Reasons for discontinuation were failed efficacy (16.0%), side effects (7.0%) or safety issues (16.0 %) such as proarrhythmia (6.7%), heart failure (2.2%), coronary heart disease (1.5%), QRS widening (1.5%), QTc ≥500 ms (0.7%) or AV block II (0.7%). Age ≥60 years, male gender, height and LAE were significant predictors of therapy discontinuation in the univariate analysis, however only LAE (HR=3.9 95% CI 1.1-13.5 for the primary (Figure A) and HR=2.5 95%CI 1.3-4.9 for the secondary endpoints) and age ≥60 years (HR=3.9 95% CI 1.1-11.9 for the primary and HR=2.2 95%CI 1.1-4.3 for the secondary endpoint) remained independent predictors of therapy discontinuation in the multivariate analysis. The outcome did not differ between paroxysmal and persistent AF (Figure B). [Formula presented] [Formula presented] Conclusion: LAE and age ≥60 years were associated with flecainide rhythm control failure in patients with recurrent AF. The vast majority of all treatment failures occured within 6 months from the treatment start. AF type did not significantly predict treatment efficacy. (Less)
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organization
publishing date
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Contribution to journal
publication status
published
subject
keywords
flecainide, adult, atrial fibrillation, atrioventricular block, CHA2DS2-VASc score, clinical feature, cohort analysis, conference abstract, controlled study, drug efficacy, drug safety, drug therapy, drug withdrawal, female, follow up, gender, heart failure, heart left atrium, heart proarrhythmia, human, ischemic heart disease, Kaplan Meier method, major clinical study, male, medical record, middle aged, outcome assessment, persistent atrial fibrillation, QTc interval, retrospective study, side effect, treatment failure, univariate analysis
in
Heart Rhythm
volume
19
issue
5
article number
PO-669-01
pages
315 - 316
publisher
Elsevier
ISSN
1556-3871
DOI
10.1016/j.hrthm.2022.03.396
language
English
LU publication?
yes
id
fe540080-521a-4a8e-8034-fa62463e1d76
date added to LUP
2023-03-02 10:11:23
date last changed
2023-03-02 15:11:50
@misc{fe540080-521a-4a8e-8034-fa62463e1d76,
  abstract     = {{Background: The choice of rhythm control drugs for recurrent atrial fibrillation (AF) remains empirical and is based on the safety profile rather than predicted efficacy. Flecainide is recommended for prevention of AF recurrence in patients without structural heart disease however predictors of treatment success are insufficiently studied. Objective: To assess clinical characteristics associated with flecainide treatment success in patients with recurrent AF. Methods: Using hospital medical records, 135 consecutive adult AF patients who were referred for in-hospital initiation of flecainide were included (median age 62 (IQR 53-70) years, 35% females, 28% persistent AF, median CHA2DS2-VASc score 1, median follow up time 14.5 (IQR 3.3-32.7) months). Patient characteristics at admission, including left atrial enlargement (LAE) assessed as LA volume index >34 ml/m2, were retrieved from medical records. Kaplan Meier curve and Cox regression analysis were used to analyse the association between the clinical characteristics and the likelihood of the drug discontinuation due to failed rhythm control efficacy (primary endpoint) or discontinuation for any reason (secondary endpoint). Results: By the end of follow up 88 patients (65.0%) had continued flecainide therapy. Reasons for discontinuation were failed efficacy (16.0%), side effects (7.0%) or safety issues (16.0 %) such as proarrhythmia (6.7%), heart failure (2.2%), coronary heart disease (1.5%), QRS widening (1.5%), QTc ≥500 ms (0.7%) or AV block II (0.7%). Age ≥60 years, male gender, height and LAE were significant predictors of therapy discontinuation in the univariate analysis, however only LAE (HR=3.9 95% CI 1.1-13.5 for the primary (Figure A) and HR=2.5 95%CI 1.3-4.9 for the secondary endpoints) and age ≥60 years (HR=3.9 95% CI 1.1-11.9 for the primary and HR=2.2 95%CI 1.1-4.3 for the secondary endpoint) remained independent predictors of therapy discontinuation in the multivariate analysis. The outcome did not differ between paroxysmal and persistent AF (Figure B). [Formula presented] [Formula presented] Conclusion: LAE and age ≥60 years were associated with flecainide rhythm control failure in patients with recurrent AF. The vast majority of all treatment failures occured within 6 months from the treatment start. AF type did not significantly predict treatment efficacy.}},
  author       = {{Siotis, Alexander and Madsen Hardig, Bjarne and Johansson, Samuel and Carlson, Jonas and Wagner, Henrik and Platonov, P.G.}},
  issn         = {{1556-3871}},
  keywords     = {{flecainide; adult; atrial fibrillation; atrioventricular block; CHA2DS2-VASc score; clinical feature; cohort analysis; conference abstract; controlled study; drug efficacy; drug safety; drug therapy; drug withdrawal; female; follow up; gender; heart failure; heart left atrium; heart proarrhythmia; human; ischemic heart disease; Kaplan Meier method; major clinical study; male; medical record; middle aged; outcome assessment; persistent atrial fibrillation; QTc interval; retrospective study; side effect; treatment failure; univariate analysis}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  number       = {{5}},
  pages        = {{315--316}},
  publisher    = {{Elsevier}},
  series       = {{Heart Rhythm}},
  title        = {{LONG-TERM ADHERENCE TO FLECAINIDE AS A RHYTHM CONTROL THERAPY IN RECURRENT ATRIAL FIBRILLATION - A RETROSPECTIVE COHORT STUDY}},
  url          = {{http://dx.doi.org/10.1016/j.hrthm.2022.03.396}},
  doi          = {{10.1016/j.hrthm.2022.03.396}},
  volume       = {{19}},
  year         = {{2022}},
}