Long-term adherence to flecainide as a rhythm control therapy in recurrent atrial fibrillation – a retrospective cohort study
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| Title: | Long-term adherence to flecainide as a rhythm control therapy in recurrent atrial fibrillation – a retrospective cohort study |
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| Authors: | Siotis, Alexander, Johansson, Samuel, Graff, Claus, Madsen Härdig, Bjarne, Platonov, Pyotr |
| Contributors: | Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Clinical Sciences, Helsingborg, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kliniska Vetenskaper, Helsingborg, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Cardiology, Electrocardiology Research Group - CIEL, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kardiologi, Electrocardiology Research Group - CIEL, Originator |
| Source: | Scandinavian Cardiovascular Journal. 59(1):1-10 |
| Subject Terms: | Medical and Health Sciences, Clinical Medicine, Cardiology and Cardiovascular Disease, Medicin och hälsovetenskap, Klinisk medicin, Kardiologi och kardiovaskulära sjukdomar |
| Description: | 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. |
| File Description: | electronic |
| Access URL: | https://lucris.lub.lu.se/ws/files/222200072/Long-term_adherence_to_flecainide_as_a_rhythm_control_therapy_in_recurrent_atrial_fibrillation_a_retrospective_cohort_study-1.pdf |
| Database: | SwePub |
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