Propafenone use in coronary artery disease patients undergoing atrial fibrillation ablation.

Publisher: Springer Country of Publication: Netherlands NLM ID: 9708966 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1572-8595 (Electronic) Linking ISSN: 1383875X NLM ISO Abbreviation: J Interv Card Electrophysiol Subsets: MEDLINE

Publication: Amsterdam : Springer
Original Publication: Norwell, MA : Kluwer Academic Publishers, c1997-

Atrial Fibrillation*/drug therapy ; Atrial Fibrillation*/surgery ; Coronary Artery Disease*/complications ; Coronary Artery Disease*/drug therapy ; Coronary Artery Disease*/surgery ; Amiodarone* ; Tachycardia, Ventricular*/drug therapy; Humans ; Propafenone/therapeutic use ; Retrospective Studies ; Longitudinal Studies ; Treatment Outcome ; Anti-Arrhythmia Agents/therapeutic use ; Death, Sudden, Cardiac/prevention & control

Background: Antiarrhythmic drugs (AADs) are frequently used after atrial fibrillation (AF) ablation. Class IC AAD use after AF ablation in patients with coronary artery disease (CAD) is uncertain. The aim was to evaluate propafenone use in CAD patients undergoing AF ablation and to compare propafenone with amiodarone regarding ventricular arrhythmia and mortality.
Methods: In this retrospective, longitudinal cohort study, consecutive patients with mild to moderate CAD, undergoing AF ablation and receiving either propafenone (study group, n = 263) or amiodarone (control group, n = 499) in the blanking period, were included. After propensity score matching, 212 patients in each group were compared for the primary outcome defined as a composite of ventricular arrhythmic events, which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or non-sustained ventricular tachycardia (NSVT). Cardiovascular and non-cardiovascular mortality were evaluated as secondary outcomes.
Results: Baseline variables of the study and control groups were well matched after propensity score matching. At 12-month follow up, 20 patients (4.7%) (11 in propafenone group and 9 in amiodarone group) experienced the primary outcome measure of NSVT (Gray test p = 0.645). No sustained ventricular tachycardia, ventricular fibrillation, sudden cardiac death, or cardiovascular mortality were observed. On multivariable competing analysis, age and diabetes but not propafenone use (hazard ratio 1.017; p = 0.804) were found to be independent and significant predictors of the primary outcome measure.
Conclusion: Propafenone use after AF ablation in patients with mild to moderate CAD had a safety profile similar to amiodarone and was not associated with major arrhythmic events.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Comment in: J Interv Card Electrophysiol. 2022 Nov;65(2):347-348. (PMID: 35793008)

Hermida JS, Chen J, Meyer C, Iacopino S, Arena G, Pavlovic N, et al. Cryoballoon catheter ablation versus antiarrhythmic drugs as a first-line therapy for patients with paroxysmal atrial fibrillation: rationale and design of the international Cryo-FIRST study. Am Heart J. 2020;222:64–72. https://doi.org/10.1016/j.ahj.2019.12.006 . (PMID: 10.1016/j.ahj.2019.12.00632018203)
Leong-Sit P, Roux JF, Zado E, Callans DJ, Garcia F, Lin D, et al. Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study. Circ Arrhythm Electrophysiol. 2011;4:11–4. https://doi.org/10.1161/CIRCEP.110.955393 . (PMID: 10.1161/CIRCEP.110.95539321076158)
Valderrabano M, Singh BN. Electrophysiologic and antiarrhythmic effects of propafenone: focus on atrial fibrillation. J Cardiovasc Pharmacol Ther. 1999;4:183–98. https://doi.org/10.1177/107424849900400308 . (PMID: 10.1177/10742484990040030810684540)
Stirrup J, Wechalekar K, Maenhout A, Anagnostopoulos C. Cardiac radionuclide imaging in stable coronary artery disease and acute coronary syndromes. Br Med Bull. 2009;89:63–78. https://doi.org/10.1093/bmb/ldp004 . (PMID: 10.1093/bmb/ldp00419179343)
Pantlin PG, Bober RM, Bernard ML, Khatib S, Polin GM, Rogers PA, et al. Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease. J Cardiovasc Electrophysiol. 2020;31:607–11. https://doi.org/10.1111/jce.14335 . (PMID: 10.1111/jce.14335319129337079139)
Tomomatsu T, Morishima I, Okumura K, Tsuboi H, Morita Y, Takagi K, et al. Comparison of frequency and characteristics of patients with atrial fibrillation having ablation with versus without coronary narrowing (>/=50%) by angiography. Am J Cardiol. 2017;119:1770–5. https://doi.org/10.1016/j.amjcard.2017.02.047 . (PMID: 10.1016/j.amjcard.2017.02.04728427735)
Hiraya D, Sato A, Hoshi T, Watabe H, Yoshida K, Komatsu Y, et al. Impact of coronary artery disease and revascularization on recurrence of atrial fibrillation after catheter ablation: importance of ischemia in managing atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30:1491–8. https://doi.org/10.1111/jce.14029 . (PMID: 10.1111/jce.1402931190437)
Sutton NR, Seth M, Ruwende C, Gurm HS. Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2016;68:895–904. https://doi.org/10.1016/j.jacc.2016.05.085 . (PMID: 10.1016/j.jacc.2016.05.08527561762)
Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825–33. https://doi.org/10.1056/NEJMoa021328 . (PMID: 10.1056/NEJMoa02132812466506)
Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321:1261–74. https://doi.org/10.1001/jama.2019.0693 . (PMID: 10.1001/jama.2019.0693308747666450284)
Podrid PJ, Anderson JL. Safety and tolerability of long-term propafenone therapy for supraventricular tachyarrhythmias The Propafenone Multicenter Study Group. Am J Cardiol. 1996;78:430–4. (PMID: 10.1016/S0002-9149(96)00332-38752188)
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1-76. https://doi.org/10.1016/j.jacc.2014.03.022 . (PMID: 10.1016/j.jacc.2014.03.02224685669)
Dukes ID, Vaughan Williams EM. The multiple modes of action of propafenone. Eur Heart J. 1984;5:115–25. https://doi.org/10.1093/oxfordjournals.eurheartj.a061621 . (PMID: 10.1093/oxfordjournals.eurheartj.a0616216144546)
Hyman MC, Mustin D, Supple G, Schaller RD, Santangeli P, Arkles J, et al. Class IC antiarrhythmic drugs for suspected premature ventricular contraction-induced cardiomyopathy. Heart Rhythm. 2018;15:159–63. https://doi.org/10.1016/j.hrthm.2017.12.018 . (PMID: 10.1016/j.hrthm.2017.12.01829405947)
Singh BN, Kaplinsky E, Kirsten E, Guerrero J. Effects of propafenone on ventricular arrhythmias: double-blind, parallel, randomized, placebo-controlled dose-ranging study. Am Heart J. 1988;116:1542–51. https://doi.org/10.1016/0002-8703(88)90741-7 . (PMID: 10.1016/0002-8703(88)90741-73057844)
Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324:781–8. https://doi.org/10.1056/NEJM199103213241201 . (PMID: 10.1056/NEJM1991032132412011900101)
Anderson JL, Pratt CM, Waldo AL, Karagounis LA. Impact of the Food and Drug Administration approval of flecainide and encainide on coronary artery disease mortality: putting “Deadly Medicine” to the test. Am J Cardiol. 1997;79:43–7. https://doi.org/10.1016/s0002-9149(96)00673-x . (PMID: 10.1016/s0002-9149(96)00673-x9024734)
Zimetbaum P. Antiarrhythmic drug therapy for atrial fibrillation. Circulation. 2012;125:381–9. https://doi.org/10.1161/CIRCULATIONAHA.111.019927 . (PMID: 10.1161/CIRCULATIONAHA.111.01992722249528)
Freemantle N, Lafuente-Lafuente C, Mitchell S, Eckert L, Reynolds M. Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation. Europace. 2011;13:329–45. https://doi.org/10.1093/europace/euq450 . (PMID: 10.1093/europace/euq45021227948)
Kerr CR, Klein GJ, Axelson JE, Cooper JC. Propafenone for prevention of recurrent atrial fibrillation. Am J Cardiol. 1988;61:914–6. https://doi.org/10.1016/0002-9149(88)90373-6 . (PMID: 10.1016/0002-9149(88)90373-63354467)
Soyka LF. Safety of encainide for the treatment of ventricular arrhythmias. Am J Cardiol. 1986;58:96C-103C. https://doi.org/10.1016/0002-9149(86)90111-6 . (PMID: 10.1016/0002-9149(86)90111-63092626)
Anderson JL, Platia EV, Hallstrom A, Henthorn RW, Buckingham TA, Carlson MD, et al. Interaction of baseline characteristics with the hazard of encainide, flecainide, and moricizine therapy in patients with myocardial infarction. A possible explanation for increased mortality in the Cardiac Arrhythmia Suppression Trial (CAST). Circulation. 1994;90:2843–52. https://doi.org/10.1161/01.cir.90.6.2843 . (PMID: 10.1161/01.cir.90.6.28437994829)
Bonatti R, Silva AF, Batatinha JA, Sobrado LF, Machado AD, Varone BB, et al. Selective late sodium current blockade with GS-458967 markedly reduces ischemia-induced atrial and ventricular repolarization alternans and ECG heterogeneity. Heart Rhythm. 2014;11:1827–35. https://doi.org/10.1016/j.hrthm.2014.06.017 . (PMID: 10.1016/j.hrthm.2014.06.01724953379)
Corley SD, Epstein AE, DiMarco JP, Domanski MJ, Geller N, Greene HL, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004;109:1509–13. https://doi.org/10.1161/01.CIR.0000121736.16643.11 . (PMID: 10.1161/01.CIR.0000121736.16643.1115007003)
Almroth H, Andersson T, Fengsrud E, Friberg L, Linde P, Rosenqvist M, et al. The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events. J Intern Med. 2011;270:281–90. https://doi.org/10.1111/j.1365-2796.2011.02395.x . (PMID: 10.1111/j.1365-2796.2011.02395.x21635583)
Bardai A, Blom MT, van Hoeijen DA, van Deutekom HW, Brouwer HJ, Tan HL. Atrial fibrillation is an independent risk factor for ventricular fibrillation: a large-scale population-based case-control study. Circ Arrhythm Electrophysiol. 2014;7:1033–9. https://doi.org/10.1161/CIRCEP.114.002094 . (PMID: 10.1161/CIRCEP.114.00209425236735)
Lin CY, Lin YJ, Lo LW, Chen YY, Chong E, Chang SL, et al. Factors predisposing to ventricular proarrhythmia during antiarrhythmic drug therapy for atrial fibrillation in patients with structurally normal heart. Heart Rhythm. 2015;12:1490–500. https://doi.org/10.1016/j.hrthm.2015.04.018 . (PMID: 10.1016/j.hrthm.2015.04.01825889809)
Field ME, Holmes DN, Page RL, Fonarow GC, Matsouaka RA, Turakhia MP, et al. Guideline-concordant antiarrhythmic drug use in the get with the guidelines-atrial fibrillation registry. Circ Arrhythm Electrophysiol. 2021;14:e008961. https://doi.org/10.1161/CIRCEP.120.008961 . (PMID: 10.1161/CIRCEP.120.00896133419385)
Chimienti M, Cullen MT Jr, Casadei G. Safety of flecainide versus propafenone for the long-term management of symptomatic paroxysmal supraventricular tachyarrhythmias. Report from the Flecainide and Propafenone Italian Study (FAPIS) Group. Eur Heart J. 1995;16:1943–51. https://doi.org/10.1093/oxfordjournals.eurheartj.a060852 . (PMID: 10.1093/oxfordjournals.eurheartj.a0608528682031)
Bunch TJ, May HT, Cruz J, Bair TL, Weiss JP, Day JD, et al. Long-term outcomes in patients treated with flecainide for atrial fibrillation with stable coronary artery disease. Circulation. 2019;140:A15355.
McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern Med. 2003;139:1018–33. https://doi.org/10.7326/0003-4819-139-12-200312160-00012 . (PMID: 10.7326/0003-4819-139-12-200312160-0001214678922)
Andersen SS, Hansen ML, Gislason GH, Schramm TK, Folke F, Fosbol E, et al. Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study. Europace. 2009;11:886–91. https://doi.org/10.1093/europace/eup119 . (PMID: 10.1093/europace/eup11919443433)

Keywords: Atrial fibrillation ablation; Coronary artery disease; Propafenone; Ventricular arrhythmia

68IQX3T69U (Propafenone)
0 (Anti-Arrhythmia Agents)
N3RQ532IUT (Amiodarone)

Date Created: 20220402 Date Completed: 20221109 Latest Revision: 20221109

20231215

10.1007/s10840-022-01186-0

35366133