Europace Advance Access originally published online on May 14, 2009
Europace 2009 11(7):886-891; doi:10.1093/europace/eup119
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Drug Therapy for Atrial Fibrillation
Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study
1 Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup, Copenhagen DK-2900, Denmark; 2 Department of Cardiology, The Heart Centre, Rigshospitalet–Copenhagen University Hospital, Copenhagen, Denmark; 3 Department of Cardiology, Glostrup University Hospital, Glostrup, Denmark; 4 National Institute of Public Health, Copenhagen, Denmark
Aims: To examine the risk of death associated with antiarrhythmic drug (AAD) therapy in a nationwide unselected cohort of patients with atrial fibrillation (AF).
Methods and results: All patients admitted with AF in Denmark from 1995 to 2004 and their subsequent use of AADs were identified by individual-level linkage of nationwide registries. Multivariable Cox proportional-hazard models with time-dependent covariates were used to analyse the risk of death associated with AAD therapy. A total of 141 500 patients were included in the study; of these 3356 (2.4%) patients received treatment with flecainide, 3745 (2.6%) propafenone, 23 346 (16.5%) sotalol, and 10 376 (7.3%) amiodarone. Annualized mortality rates were 2.54, 4.25, 5.29, and 7.42 per year per 100 person years for flecainide, propafenone, sotalol, and amiodarone, respectively. Multivariable Cox proportional-hazard models did not show increased risk of death associated with any of the AADs. Hazard ratio (95% confidence interval) for flecainide 0.38 (0.32–0.44), propafenone 0.65 (0.58–0.71), sotalol 0.65 (0.63–0.67), and amiodarone 0.94 (0.89–1.00).
Conclusion: In an unselected cohort of patients with AF, antiarrhythmic treatment with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death. From a safety perspective, this indicates appropriate selection of patients for AAD therapy.
Key Words: Antiarrhythmic drug therapy, Atrial fibrillation
* Corresponding author. Tel: +45 20 27 01 83, Fax: +45 70 20 12 81, Email: ssa{at}heart.dk
Manuscript submitted 3 February 2009. Accepted after revision 21 April 2009.
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