Flecainide use before and after the Cardiac Arrhythmia Suppression Trial: A systematic review

Heart Rhythm 2026 Open access

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Authors: Christopher O.Y. Li, Samantha Wong, Melanie Kardel, Sonia Franciosi, Abhay Katyal, Matthew M. Cheung, Sabrina Wei, Melissa C. Braschel, Thomas M. Roston, Sakethram Saravu Vijayashankar, Shubhayan Sanatani
DOI: 10.1016/j.hrthm.2026.02.010
Cited by: 1
References: 5

Abstract

The 1989 Cardiac Arrhythmia Suppression Trial (CAST) remains a defining moment in modern cardiology. It dismantled the hypothesis that arrhythmia suppression was synonymous with improved survival after it demonstrated that ventricular ectopy suppression with class IC anti-arrhythmics, including flecainide, paradoxically increased mortality in patients with prior myocardial infarction (MI).1 Since then, flecainide acetate has evolved from a broad-spectrum suppressor of ventricular ectopy to a targeted therapy for atrial fibrillation (AF) and inherited arrhythmia syndromes in structurally normal hearts.

Fields of Study & Subjects

Anesthesia and Sedative Agents Cardiac electrophysiology and arrhythmias Poisoning and overdose treatments

Publication details

Journal / source
Heart Rhythm
Publisher
Elsevier BV
Volume
23
Issue
8
Pages
e1383–e1384
Publication date
14 February 2026
Language
EN