Propafenone reduces risks of proarrhythmia, death in AF patients with HF

The use of propafenone shows no significant relationship with an elevated risk of proarrhythmia and mortality compared with amiodarone in atrial fibrillation (AF) patients with heart failure (HF), suggests a recent study.

The authors obtained data from the National Health Insurance Research Database in Taiwan for this population-based cohort study. They identified patients who had AT or atrial flutter diagnosis, had HF diagnosis, and first received propafenone or amiodarone between 2002 and 2018.

Death due to arrhythmia and the composite proarrhythmic outcome, which consisted of sudden cardiac arrest, arrhythmic death, ventricular arrhythmia, and implantation of defibrillation, were the primary endpoints.

After propensity score matching, the study cohort consisted of 7,235 and 14,470 users of propafenone and amiodarone, respectively.

Propafenone use resulted in a significantly lower risk of the composite proarrhythmic outcome (adjusted hazard ratio [aHR], 0.52, 95 percent confidence interval [CI], 0.42–0.64; p<0.001) compared with using amiodarone. Users of propafenone also had a lower risk of death due to arrhythmia than amiodarone users (aHR, 0.22, 95 percent CI, 0.08–0.65; p=0.006).

Similar trends favouring propafenone were observed in both subgroup and sensitivity analyses.

“Prospective studies are needed to determine whether propafenone should definitely be avoided in these patients,” the authors said.