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Class IC vs. Class III Antiarrhythmic Drugs for AF
Study Questions:
Are there any differences in outcomes in patients with atrial fibrillation (AF) treated with a class IC drug (flecainide or propafenone) versus a class III drug (sotalol or dofetilide)?
Methods:
This was a retrospective cohort study based on the analysis of the TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) database accumulated in 2004-2014. Patients with newly diagnosed AF who received a prescription for a class IC or III antiarrhythmic drug and who did not have a contraindication to treatment were included in this study. The primary outcome was hospitalization for AF.
Results:
A class IC drug was prescribed in 3,973 patients and a class III drug in 6,909 patients. After a median of 4.9 years of follow-up and correction for multiple potentially confounding demographic, clinical, and laboratory variables along with non-antiarrhythmic drug therapies, class IC drugs were associated with a significantly lower probability of the primary outcome (hazard ratio [HR], 0.77) and also a significantly lower probability of ischemic stroke (HR, 0.74) and of hospitalization for cardiovascular disease (HR, 0.78) and heart failure (HR, 0.70).
Conclusions:
Class IC drugs are associated with a lower probability of hospitalization and cardiovascular events.
Perspective:
The results of prior studies have indicated that class IC and class III drugs (except for amiodarone) are equally or nearly equally efficacious. The present study focused on outcomes other than efficacy. The results suggest that class IC drugs may be more appropriate than class II drugs as first-line rhythm control agents for patients with AF. As in most retrospective cohort studies, the possibility of a confounding variable that was not accounted for (e.g., ejection fraction, AF burden) cannot be ruled out, and the evidence provided by this study should not be considered robust.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Amiodarone, Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Brain Ischemia, Flecainide, Heart Failure, Propafenone, Secondary Prevention, Sotalol, Stroke, Stroke Volume
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