Initiation and outcomes with Class Ic antiarrhythmic drug therapy

Xu Gao, Avirup Guha, Benjamin Buck, Dilesh Patel, Melissa J. Snider, Michael Boyd, Muhammad Afzal, Auroa Badin, Hemant Godara, Zhenguo Liu, Jaret Tyler, Raul Weiss, Steven Kalbfleisch, John Hummel, Ralph Augostini, Mahmoud Houmsse, Emile G. Daoud

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Expert opinion recommends performing exercise testing with initiation of Class Ic antiarrhythmic medication. Objective: To evaluate the rate and reason for discontinuation of Ic agent within the first year of follow up, with particular attention to rate of proarrhythmia and the value of routine treadmill testing. Methods: This is a single center retrospective cohort study including consecutive patients with atrial arrhythmias who were initiated on a Class Ic agent from 2011 to 2016. Data was collated from chart review and pharmacy database. Results: The study population included 300 patients (55% male, mean age 61; mean ejection fraction, 56%) started on flecainide (n = 153; 51%) and propafenone (n = 147; 49%). Drug initiation was completed while hospitalized on telemetry and the staff electrophysiologists directed dosing. There was one proarrhythmic event during initiation (0.3%). The primary reason for not being discharged on Ic agent was due to detection of proarrhythmia (n = 15) or ischemia (n = 1) with treadmill testing (5.3%). Exercise testing was the single significant variable to affect the decision to discontinue Ic drug, p < 0.0001 (95% CI: 1.89–6.08%). During follow up, the primary reason for discontinuation of Ic agent was lack of efficacy, 32%. Conclusions: With proper screening, initiation of Class Ic agent is associated with very low rate of proarrhythmia. Treadmill testing is of incremental value and should be completed in all patients after loading Class Ic antiarrhythmic.

Original languageEnglish (US)
Pages (from-to)68-72
Number of pages5
JournalIndian Pacing and Electrophysiology Journal
Volume18
Issue number2
DOIs
StatePublished - Mar 1 2018

Keywords

  • Antiarrhythmic medication
  • Atrial fibrillation
  • Exercise stress testing
  • Flecainide
  • Proarrhythmia
  • Propafenone

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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