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How Common Are Potential Contraindications to Atrial Antiarrhythmic Drugs?

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How Common Are Potential Contraindications to Atrial Antiarrhythmic Drugs?

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The potential for side effects of atrial antiarrhythmic drugs is increased in the setting of comorbidities. In a study of 723 Canadian patients with paroxysmal atrial fibrillation entered into a prospective registry between 1991 and 1996, Humphries et al55 noted that 56% had documented structural heart disease, including 22% with left ventricular systolic dysfunction. When they sought the presence of a clinical feature that was specified as a contraindication, warning, or precaution to a specific drug in the 1996 Canadian Compendium of Pharmaceuticals and Specialties, the percentage of patients who fell into at least 1 such category among the most commonly prescribed drugs (flecainide, quinidine, sotalol, amiodarone, and propafenone) ranged from 36% for quinidine to 58% for flecainide. Although, as the authors appropriately point out, these were only potential limitations to drug use and do not necessarily preclude therapy based on good clinical judgment, these data certainly underscor

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