Burnham TS, May HT, Bair TL, et al. - A favorable safety profile of flecainide for atrial fibrillation (AF), relative to class-3 antiarrhythmic drugs (AADs), was evident in select patients with stable coronary artery disease (CAD).

• Consensus guidelines recommend not using class 1C AADs in stable CAD as these drugs have been linked with harm in patients treated for ventricular arrhythmias with a prior myocardial infarction (MI).

• This study investigated safety of these drugs when used for AF in patients with CAD without a prior MI.

• A total of 24,315 patients were treated with the initiation of AADs.

• Two groups were assessed: 1. propensity-matched AF patients with CAD were created based upon AAD class (flecainide, n=1,114, vs class-3 AAD, n=1,114); 2. AF patients who had received a PCI or CABG (flecainide, n=150, and class-3 AAD, n=1,453).

• At 3 years, significantly lower mortality, heart failure (HF) hospitalization, MACE, and ventricular tachycardia (VT) rates were evident in the flecainide group for population 1.

• Population 2 exhibited lower adverse event rates, although not significantly, in the flecainide vs class-3 AAD group for mortality, HF hospitalization, VT and MACE.