Sangpornsuk Naruepat, Rungpradubvong Voravut, Tiensantisuk Tachawut, Leelapattana Pattranee, Chokesuwattanakul Ronpichai, Prechawat Somchai
Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Ther Adv Drug Saf. 2025 Feb 12;16:20420986251316462. doi: 10.1177/20420986251316462. eCollection 2025.
Current guidelines recommend the use of only on a limited basis in patients with normal or minimal structural heart disease. The CAST study, the only randomized controlled trials, showed increased mortality from long-term flecainide use in post-myocardial infarction (MI) patients with reduced left ventricular ejection fraction (LVEF). However, many later studies have revealed its safety when used in other structural heart diseases.
This study investigates the incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) VT/VF in patients with structural heart disease compared to those with a normal heart when using flecainide.
We retrospectively recruited patients who had received at least one dose of flecainide in the past 5 years. Baseline characteristics, indications for flecainide use, and echocardiography results were reviewed. After 1 year, we evaluated the incidence of ventricular arrhythmias and all-cause mortality.
After screening, 447 patients had received at least one dose of flecainide, and 336 patients were included in the study. Forty-seven patients (14%) had structural heart disease as defined by our protocols. Left ventricular hypertrophy (LVH) and impaired LVEF accounted for 28% and 25% of cases, respectively. There were five patients with coronary artery disease (CAD). After 1 year, ventricular arrhythmias occurred in two patients (4.7%) in the structural heart group; these patients had also experienced arrhythmias before receiving flecainide. In the non-structural heart group, ventricular arrhythmias were detected in three patients (1.1%). In multivariate analysis, structural heart disease was not associated with an increased incidence of ventricular arrhythmias (OR = 4.8 (0.6-38.44), = 0.139).
Our study showed that no patients died due to ventricular arrhythmia, and the incidence of VT/VF was not increased in patients with structural heart disease. A prospective study is needed to further evaluate the safety of flecainide in patients with structural heart disease other than ischemic heart disease.
目前的指南建议仅在结构正常或轻度异常的心脏病患者中有限使用。CAST研究是唯一的随机对照试验，结果显示，在左心室射血分数（LVEF）降低的心肌梗死（MI）后患者中，长期使用氟卡尼会增加死亡率。然而，许多后续研究表明，在其他结构性心脏病中使用时它是安全的。
本研究调查与心脏正常的患者相比，结构性心脏病患者使用氟卡尼时室性心动过速（VT）或室性颤动（VF）（VT/VF）的发生率。
我们回顾性招募了在过去5年中至少接受过一剂氟卡尼的患者。回顾了基线特征、使用氟卡尼的指征和超声心动图结果。1年后，我们评估了室性心律失常的发生率和全因死亡率。
经过筛查，447例患者至少接受过一剂氟卡尼，336例患者纳入研究。47例患者（14%）患有我们方案定义的结构性心脏病。左心室肥厚（LVH）和LVEF受损分别占病例的28%和25%。有5例冠状动脉疾病（CAD）患者。1年后，结构性心脏病组有2例患者（4.7%）发生室性心律失常；这些患者在接受氟卡尼之前也有过心律失常。在非结构性心脏病组中，3例患者（1.1%）检测到室性心律失常。多因素分析显示，结构性心脏病与室性心律失常发生率增加无关（OR = 4.8（0.6 - 38.44），P = 0.139）。
我们的研究表明，没有患者因室性心律失常死亡，结构性心脏病患者的VT/VF发生率没有增加。需要进行前瞻性研究以进一步评估氟卡尼在缺血性心脏病以外的结构性心脏病患者中的安全性。
