Flecainide useful for achieving and maintaining Sinus rhythm among young patients with rheumatic AF
Rheumatic heart disease is the common etiology in patients with Atrial fibrillation (AF). These patients have a higher rate of thromboembolic complications. Many patients with rheumatic AF are young. There are long-term adverse effects secondary to Amiodarone, so exploring other rhythm control options for these patients is imperative.
In a recent study published in the Indian Heart Journal, researchers demonstrated the safety and effectiveness of Oral Flecainide in post-mitral valve replacement (MVR) rheumatic AF patients; maintenance of SR was achieved in 76% of initial converters and 64% of the overall population, with better LA strain values.
Despite successful MVR, many patients remain in AF. Flecainide could be useful in these patients but not used due to underlying structural heart disease. In this study, researchers assessed the safety and efficacy of oral Flecainide in rheumatic AF following MVR for conversion and maintenance of SR in 25 patients aged 34.4 years with a mean AF duration of 3.6 years. Non-converters underwent DC cardioversion at 24 h and four weeks. Patients received Flecainide and bb/diltiazem at discharge.
Key results of the study are:
- A single oral dose of Flecainide achieved SR in 6 patients (24%). Nineteen patients achieved SR after DCC; at 24 h, 21 patients (84%) were in SR.
- With the mean flecainide dose, 16 patients had successful maintenance of SR at six months.
- Researchers reported no significant changes in PR interval, QRS duration or QTc were noted.
- Flecainide was well tolerated.
- At six months, Patients in SR had better functional status, QOL scores and higher LA strain.
- Baseline LA diameter ≤ 61 mm predicted SR at six months (sensitivity/specificity 93.7% and 85.71%), while the values for AF duration ≤ 4 years and LA strain > 21% for predicting SR were 87.5/71.43% and 100/85.71% respectively.
They said that Flecainide may be an attractive modality for achieving and maintaining SR for rheumatic AF.
The study has a small number of patients. More studies need to be carried out with longer follow-ups, they said. The researchers acknowledged the lack of comparison with other drugs as another limitation.
Reference:
Tripathi, U., Kapoor, A., Agarwal, S. K., Tewari, P., Pande, S., Chandra, B., Sahu, A. K., Khanna, R., Kumar, S., Garg, N., & Tewari, S. (2023). Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillation. Indian Heart Journal. https://doi.org/10.1016/j.ihj.2023.07.001
