Vol.:(0123456789) American Journal of Cardiovascular Drugs (2021) 21:563–572 https://doi.org/10.1007/s40256-021-00483-9 ORIGINAL RESEARCH ARTICLE Use of Flecainide in Stable Coronary Artery Disease: An Analysis of Its Safety in Both Nonobstructive and Obstructive Coronary Artery Disease Hasan Ashraf 1  · Nway Ko Ko 1  · Vatsal Ladia 1  · Pradyumna Agasthi 1  · Tadhg Prendiville 2  · Fergus O’Herlihy 2  · Sai Harika Pujari 1  · Siva K. Mulpuru 3  · Luis Scott 1  · Dan Sorajja 1 Accepted: 3 May 2021 / Published online: 18 June 2021 © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021 Abstract Background Flecainide is a class IC antiarrhythmic drug that is contraindicated in patients who have a history of myocar- dial infarction, but its efect on mortality and risk of proarrhythmia in patients with stable obstructive and nonobstructive epicardial coronary artery disease (CAD) has not been assessed. Objective We sought to compare the safety of fecainide administration in patients who had angiographic evidence of either no or minimal CAD versus nonobstructive CAD, and those who underwent nuclear stress testing with perfusion defects versus those without perfusion defects. Methods We conducted a retrospective chart review of 348 patients who were treated with fecainide for at least 1 year dura- tion and underwent evaluation for CAD with coronary angiography or myocardial perfusion imaging (MPI) stress testing within 3 months of initiating fecainide. We compared overall mortality and proarrhythmia between varying levels of CAD and perfusion defects. Results There was a similar 10-year survival between those with no or minimal CAD, nonobstructive CAD, and obstructive CAD (p = 0.6). Additionally, there was no diference in arrhythmia burden, including sustained ventricular tachycardias or frequent premature ventricular contractions (> 5% daily burden; p = 0.25). There was also no increase in mortality among those who had reversible perfusion defects >0% compared with those without, among subjects who underwent MPI (p = 0.14). On subgroup analysis, there was no increased risk in all-cause mortality with any specifc coronary artery involvement, or with obstructive multivessel CAD (p = 0.89). Conclusion Flecainide use is not associated with an increase in either all-cause mortality or ventricular arrhythmias in low- risk patients with stable nonobstructive CAD. * Hasan Ashraf ashraf.hasan@mayo.edu Nway Ko Ko koko.nway@mayo.edu Vatsal Ladia ladia.vatsal@mayo.edu Tadhg Prendiville tadhg.prendiville@ucdconnect.ie Fergus O’Herlihy oherlihy.fergus@mayo.edu Sai Harika Pujari pujari.saiharika@mayo.edu Dan Sorajja sorajja.dan@mayo.edu 1 Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA 2 Department of Internal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland 3 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA