Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 011

62y·male·white·ASCVD 14.4% · SBP 138 mmHg · LVEF 45% · Chol 198 mg/dL

1 active reversal flag

  1. CardiologyCritical

    Class 1C antiarrhythmics post-myocardial infarction

    Why flagged

    Class 1C antiarrhythmic (flecainide/encainide) contraindicated: patient has structural heart disease or prior MI; CAST 1989 showed 2.5x increase in cardiovascular mortality.

    1. Prior guidance1989

      Routine use of Class 1C antiarrhythmics to suppress PVCs following myocardial infarction to prevent sudden death (Pre-1989 standard of care).

    2. CAST1989

      Flecainide and Encainide increased cardiovascular mortality risk 2.5 times (RR 2.5; 95% CI 1.7-8.5) compared to placebo.

    3. Reversal1992

      Guidelines updated

    4. Current recommendation

      ACC/AHA guidelines: Absolute contraindication for Class 1C antiarrhythmics (flecainide, encainide) in patients with prior MI or structural heart disease.