Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting

Cardiol J. 2023;30(1):82-90. doi: 10.5603/CJ.a2022.0116. Epub 2022 Dec 13.


Background: Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na+ current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are scarce.

Methods: Patients with AF who received chronic flecainide or propafenone therapy were retrospectively studied from the database of a tertiary care center. The primary outcome of the study was clinical efficacy of Class Ic antiarrhythmics, which was assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up.

Results: Among the 361 patients (261 males, 72.3%) with a mean age of 56 ± 12 years, 287 (79.5%) were using long-term flecainide, and 74 (20.5%) patients propafenone. The majority of the patients had paroxysmal AF (n = 331, 91.7%) and had an atrioventricular-nodal blocking co-medication (n = 287, 79.5%). A total of 117 (32%) patients discontinued therapy after a median of 210 days (interquartile range 62-855 days). Clinical efficacy was observed in 188 (52%) patients. The most common reason for therapy discontinuation was adverse drug effects, particularly proarrhythmic effects (48% for flecainide and 33% for propafenone). Patients who did not clinically benefit from Class Ic antiarrhythmics more often underwent pulmonary vein isolation (p = 0.02).

Conclusions: Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in approximately half of the patients with paroxysmal or persistent AF. However, these drugs were also associated with a relatively high rate of adverse events, and in particular proarrhythmic effects, which often resulted in therapy discontinuation rendering appropriate patient selection and therapy surveillance essential.

Keywords: antiarrhythmics; atrial fibrillation; clinical outcome; flecainide; propafenone.

MeSH terms

  • Adult
  • Aged
  • Anti-Arrhythmia Agents / adverse effects
  • Atrial Fibrillation*
  • Atrioventricular Node
  • Flecainide / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Propafenone* / adverse effects
  • Retrospective Studies
  • Tertiary Healthcare


  • Propafenone
  • Flecainide
  • Anti-Arrhythmia Agents