Muzzey Mikayla, Tellor Katie B, Ramaswamy Karthik, Schwarze Martin, Armbruster Anastasia L
North Kansas City Hospital, Kansas City, MO, USA.
St. Louis College of Pharmacy, St. Louis, MO, USA.
Ther Adv Cardiovasc Dis. 2020 Jan-Dec;14:1753944720926824. doi: 10.1177/1753944720926824.
Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived.
This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months.
Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use ( = 0.024), female sex ( = 0.006), hypertension ( = 0.040), and dronedarone failure ( = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure ( = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common.
Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.
当前的心房颤动（AF）指南推荐氟卡尼作为无结构性心脏病患者的一线节律控制选择。虽然在临床试验中有已证实的疗效且有指南支持，但据推测，由于CAST试验中的负面结果，氟卡尼可能未得到充分利用，并且其不良反应比之前认为的更为少见。
这项回顾性图表审查评估了2011年8月至2016年10月期间在研究地点由心脏病专家开始使用氟卡尼治疗房颤的18岁及以上患者。排除标准包括：氟卡尼治疗时间<5天、由可逆原因引起的房颤以及记录不充分。主要结局是氟卡尼在6个月和12个月时维持症状控制的疗效。次要结局包括节律控制策略的改变特征以及6个月和12个月时心电图记录的正常窦性心律。
在识别出的326例患者中，纳入了144例患者。144例患者中的102例（70.8%）和89例（61.8%）在6个月和12个月后症状得到控制。使用阿替洛尔（P = 0.024）、女性（P = 0.006）、高血压（P = 0.040）和决奈达隆治疗失败（P = 0.012）与6个月时停用氟卡尼相关。在12个月时，只有之前普罗帕酮治疗失败（P = 0.032）具有统计学意义。144例患者中，16例（11.1%）报告有不良反应，最常见的是头晕、潮热、心动过缓和头痛（各占1.4%）。
氟卡尼是一种耐受性良好的药物，即使在12个月时也是如此，不良反应非常轻微。这些结果支持氟卡尼在指南推荐患者群体中的应用价值。
