Use of Class IC Antiarrhythmic Drugs in Atrial Fibrillation With Structural Heart Disease: A Nationwide Cohort Study in Korea

초록

Background: Use of class IC antiarrhythmic drugs (AADs) is limited in structural heart disease. This study investigated the safety of class IC AADs compared to class III AADs in patients with atrial fibrillation (AF) and structural heart disease. Methods: Based on the national health insurance database, patients first diagnosed with AF between 2013 and 2019 were screened, and those with a diagnosis of either hypertrophic cardiomyopathy, obstructive coronary artery disease, or heart failure were included. The primary outcome was the composite of all-cause mortality, sudden cardiac arrest, and ventricular arrhythmia. Results: A total of 38,378 patients were analyzed. Class IC and III AADs were prescribed to 10,034 and 28,344 patients, respectively. Patients in the class III AAD group were older and had higher CHA 2 DS 2-VASc scores than those in the class IC AAD group. The class III AAD group had a higher risk of primary outcomes (hazard ratio, 2.36; 95% confidence interval, 1.93-2.89; P < 0.001). The risks of heart failure hospitalization (4.73; 3.73-6.00; P < 0.001) and coronary revascularization (2.70; 1.85-3.95; P < 0.001) were also higher in the class III AAD group. The risk of atrial flutter did not differ significantly (1.61; 0.92-2.82; P = 0.096). Conclusion: In patients with AF and structural heart disease, class IC AADs were associated with a lower risk of adverse cardiovascular events. Further randomized trials are needed to confirm these observations. © 2027 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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