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Flecainide Treatment Linked to Sudden Cardiac Death

Last Updated: June 16, 2011.

Patients with atrial fibrillation treated with flecainide develop an increased risk of sudden cardiac death or proarrhythmic events, according to a study published online June 2 in the Journal of Internal Medicine.

THURSDAY, June 16 (HealthDay News) -- Patients with atrial fibrillation (AF) treated with flecainide develop an increased risk of sudden cardiac death (SCD) or proarrhythmic events, according to a study published online June 2 in the Journal of Internal Medicine.

Henrik Almroth, from the Örebro University Hospital in Sweden, and colleagues investigated the long-term safety of flecainide treatment in 112 patients (mean age 60 years) with paroxysmal (57 patients) or persistent (55 patients) AF. Participants initiated treatment with a mean dose of 203 mg oral flecainide per day between 1998 and 2006, which was combined with a supplement of an atrioventricular-blocking agent in 89 percent of cases. Follow-up was for an average 3.4 years. Sudden or non-sudden death, and cardiac syncope or life-threatening arrhythmia were the outcomes measured.

The investigators identified eight deaths, including three deaths classified as SCDs. Compared to the general population, patients treated with fecainide had significantly higher standardized mortality ratios for deaths due to cardiovascular disease (4.16) and all-cause mortality (1.57). Six patients developed proarrhythmic events, including two patients each with wide QRS tachycardia, 1:1 conducted atrial flutter, and syncope during exercise.

"In this real-world study of flecainide in AF patients, we found a substantially increased incidence of SCD or proarrhythmic events. Our findings indicate that SCD or proarrhythmia might occur, even in a relatively healthy AF population, despite careful evaluation before flecainide initiation and during follow-up," the authors write.

Two of the study authors disclosed financial ties to the pharmaceutical industry.

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