Based on most current research regarding the more widespread use of class IC antiarrhythmic drugs, what are your prescribing practices in patients with coronary artery disease?

To further elaborate, what level of obstruction with a normal stress test would be acceptable, and what would be too high risk? Would you consider an asymptomatic patient with incidentally found chronic total occlusion with collaterals, normal echo, and a normal exercise stress test high risk?

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How do you approach prescribing class IC antiarrhythmic drugs in patients over 50 years old with potential coronary artery disease, given the risks highlighted in recent research?

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3 Answers

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Cardiology · Heart And Vascular Center Of Arizona

Answered on

Fair question, as we know the definition of "structural heart disease" is unknown. In the trial, it was likely ischemia driving the poor outcomes, so I will get stress with imaging on everyone >50 years old (CAD risk). Given the common finding of "questionable" stent placement in the community, I wi...

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Cardiology · Private Practice

Answered on

I will continue to do ischemic evaluation for my patients I consider for 1C agents.

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Cardiology · Methodist Cardiology Clinic Of San Antonio Westover Hills

Answered on

Since we have expertise in cardiac PET-CT locally, I certainly stress these patients in consultation with my electrophysiology team. If cardiac PET-CT is not available (e.g., outreach), I lean on EP since NM-SPECT is not as robust in terms of info on coronary physiology.

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