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The Lead Episode 39: The Feasibility and Safety of Flecainide Use Among Patients With Varying Degrees of Coronary Disease
Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College, discusses the CAST trial with David J. Callans, MD, FHRS, CCDS of Hospital of the University of Pennsylvania, and Gerald V Naccarelli, MD, FHRS of Pennsylvania State University Milton S. Hershey Medical Center. Class IC antiarrhythmic drugs have been generally avoided in patients with any degree of coronary disease and any type of cardiomyopathy, whether or not they fit the inclusion criteria of the trial. For the past 3+ decades, the CAST trial results have been extrapolated to a broader population despite a lack of evidence. In this study, the authors retrospectively look at the safety of these agents compared with Class III drugs in patients with atrial fibrillation and varying degrees of CAD. 
Learning Objectives
  • Recognize that class IC antiarrhythmic drugs have not been fully studied in the entire population of patients with coronary disease
Article Authors and Podcast Contributors
Article Authors
Soroosh Kiani, MD, MS, Michael N. Sayegh, MS, PHD, Rand Ibrahim, MD, Neal K. Bhatia, MD, Faisal M. Merchant, MD, Anand D. Shah, MD, Stacy B. Westerman, MD, MPH, David B. De Lurgio, MD, Anshul M. Patel, MD, Christine M. Thompkins, MD, Angel R. Leon, MD, Michael S. Lloyd, MD, Mikhael F. El-Chami, MD

Podcast Contributors
Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College
David J. Callans, MD, FHRS, CCDS of Hospital of the University of Pennsylvania
Gerald V. Naccarelli, MD, FHRS of Pennsylvania State University Milton S. Hershey Medical Center

Disclosure Policy

ACE Disclosure Policy

The Heart Rhythm Society is committed to the provision of Accredited Continuing Education (formerly known as Continuing Medical Education (CME)) that is balanced, objective, and evidence based. HRS adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) which require that those individuals in a position to control the content of an educational activity (including, but not limited to, planners, faculty, authors, committee members, content reviewers, editors, and staff) disclose all financial relationships with an ACCME-defined ineligible company* within the 24 months prior to the disclosure.


Any individual who refuses to disclose financial relationships is disqualified from participating in HRS ACE-certified activities. Owners and employees of ACCME-defined ineligible companies may have no role in the planning or implementation of ACE activities without a special written exemption from the HRS Chief Learning Officer that will be granted only in specific circumstances that meet ACCME requirements.

ACCME Definition:

*An ineligible company is one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Examples of such organizations include:

  • Advertising, marketing, or communication firms whose clients are ineligible companies
  • Bio-medical startups that have begun a governmental regulatory approval process
  • Compounding pharmacies that manufacture proprietary compounds
  • Device manufacturers or distributors
  • Diagnostic labs that sell proprietary products
  • Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
  • Manufacturers of health-related wearable products
  • Pharmaceutical companies or distributors
  • Pharmacy benefit managers
  • Reagent manufacturers or sellers


All relevant financial relationships have been mitigated.

Host Disclosure(s):
J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s):
D. Callans: Honoraria/Speaking/Consulting: Heart Rhythm Society, Thermedical, AtriCure, Inc., Abbott Medical, Biosense Webster, Volta Medical, Mediasphere Medical, Coherex, American College of Cardiology, Best Doctors, Bayliss Medical, Biotronik, Boston Scientific, Impulse Dynamics USA: Fellowship Support: Biosense Webster, Biotronik, Boston Scientific, Medtronic, Abbott; Other Financial Relationships: Wolters Kluver

G. Naccarelli: Honoraria/Speaking/Consulting: Acesion, Sanofi, GlaxoSmithKline, Milestone, InCarda Therapeutics

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):
J. Glenn: No relevant financial relationships with ineligible companies to disclose. 
S. Sailor: No relevant financial relationships with ineligible companies to disclose.
S. Colbert: No relevant financial relationships with ineligible companies to disclose.
Availability: On-Demand
Cost: FREE
Credit Offered:
No Credit Offered
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