ClinicalTrials.gg
RecruitingNCT07405671ReCAST AFUpdated Oct 21, 2026

Flecainide Safety in Patients With Coronary Artery Disease and Atrial Fibrillation

A Phase 4 interventional study of flecainide and Sotalol or Amiodarone in Atrial Fibrillation (AF) and Coronary Artery Disease, sponsored by Universitaire Ziekenhuizen KU Leuven. Recruiting at 14 sites in Belgium. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-21.

Sponsored by Universitaire Ziekenhuizen KU Leuven · Phase 4, Interventional, and Treatment

Updated Oct 21, 2026Site recruiting status changedEligibility revisedGo to Updates ↓
Phase
Phase 4
Study type
Interventional
Enrollment
988
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The goal of this clinical trial is to learn whether the antiarrhythmic drug flecainide can be used as safely as standard rhythm-control drugs in people with atrial fibrillation (AF) and stable coronary artery disease (CAD). The study includes adults aged 18 years and older who have AF and known but stable coronary artery disease.

The main questions this study aims to answer are:

  • Is treatment with flecainide as safe as standard rhythm-control drugs (sotalol or amiodarone) in this patient group?
  • Does flecainide lead to similar or fewer serious side effects, hospitalisations, or deaths compared with standard treatment?

Researchers will compare patients treated with flecainide to patients treated with standard rhythm-control therapy (sotalol or amiodarone) to see whether flecainide is not worse in terms of safety outcomes.

Participants will:

  • Be randomly assigned to receive either flecainide or standard rhythm-control medication
  • Take the assigned medication as part of routine clinical care
  • Attend regular follow-up visits at the hospital and have additional follow-up by telephone
  • Undergo routine heart tests such as electrocardiograms and echocardiography
  • Complete questionnaires about symptoms, quality of life, and daily functioning

This study follows patients for at least one year and collects information on safety, heart rhythm outcomes, quality of life, and healthcare use.

02

Conditions studied

  • Atrial Fibrillation (AF)
  • Coronary Artery Disease

Keywords

  • atrial fibrillation
  • rhythm control
  • stable coronary artery disease
  • flecainide
  • sotalol
  • amiodarone
03

In context

Atrial Fibrillation

4,009 studies on the registry are indexed under Atrial Fibrillation; 961 are open to participants now.

This study's planned enrollment of 988 is above the median of 150 across 2,476 interventional studies indexed under Atrial Fibrillation.

Browse Atrial Fibrillation studies →

Lead sponsor

Universitaire Ziekenhuizen KU Leuven is the lead sponsor of 963 studies on the registry; 267 are open to participants now.

Of its 5 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

The criteria were revised on the registry on Oct 14, 2026. See what changed

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Voluntary written of the participant or their legally authorized representative has been obtained prior to any screening procedures
  • At least 18 years of age at the time of signing the Informed Consent Form
  • Non-permanent atrial fibrillation or ectopic atrial tachycardia with rhythm control strategy, documented on any modality in the 1 year preceding the consent date
  • Stable coronary artery disease without argument, defined as:

    1. Prior percutaneous coronary intervention; OR
    2. Prior revascularised ACS or coronary artery bypass surgery > 3 months at enrolment; OR
    3. Invasive coronary angiography demonstrating coronary atherosclerosis, defined as ≥50% diameter stenosis in at least one major epicardial coronary artery; OR
    4. Coronary CT scan showing coronary stenosis CAD-RADS stage ≥ 3 on, including CAD-RADS stages 4 and 5 in the absence of ischemia on exercise testing, myocardial perfusion imaging (MIBI), stress cardiac MRI, or fractional flow reserve.
  • ≥ 45% documented on any imaging modality*

Exclusion criteria

Exclusion Criteria:

  • \< 45%
  • class III or IV congestive heart failure
  • Active treatment with amiodarone
  • History of intolerance of flecainide or both sotalol and amiodarone
  • uncorrected hypokalemia or hypomagnesemia before initiation of trial treatment.
  • Evidence or history of thyroid dysfunction contraindicating amiodarone use, where amiodarone would be prescribed as standard of care treatment.
  • to the active substances or any .
  • Unstable angina or inducible ischemia on exercise stress testing, myocardial perfusion imaging, stress cardiac MRI, or fractional flow reserve performed for clinical indications
  • Baseline QRS duration ≥ 120 ms, unless a functioning pacemaker is present
  • Baseline interval (Fridericia) ≥ 500 ms
  • Pre-existing advanced AV block (second-, or third-degree)
  • Pre-existing sick sinus syndrome or sinus bradycardia \<50 bpm
  • Known channelopathy
  • to AV-slowing agents, including beta-blockers, diltiazem or verapamil
  • Atrial fibrillation due to reversible cause
  • Active intracardiac thrombus
  • Acute coronary syndrome during the 3-month period preceding the consent date
  • Cardiac surgery, including coronary artery bypass surgery, during the 3-month period preceding the consent date or planned at a future date at the time of consent
  • Moderate or severe congenital heart disease as per 2020 ESC guidelines
  • Hypertrophic cardiomyopathy (septal or posterior wall thickness >1.5 cm)
  • Significant chronic kidney disease ( \<40 mL/min)
  • less than 1 year
  • Female who is pregnant, breast-feeding or intends to become pregnant or is of and not using an adequate, highly effective
  • Inability to provide written , including decision-making incapacity due to cognitive impairment or other medical or psychiatric conditions that preclude adequate understanding of the study and its procedures.
  • Participation in an interventional Trial with an medicinal product (IMP) or device
Terms in these criteria, in plain language(13)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
988 participants (estimated)

Study arms

  • Experimental
    Flecainide

    Flecainide, a class Ic anti-arrhythmic drug.

    Drug: flecainide

  • Active comparator
    Sotalol or Amiodarone

    Class III anti-arrhythmic drug: sotalol or amiodarone as per physician preference.

    Drug: Sotalol or Amiodarone

Interventions

  • Flecainide, a class Ic anti-arrhythmic drug Recommended starting dose of 100 to 150 mg per day per os, either spread in 2 equal doses BID or in 1 dose OD with controlled release formulation. Flecainide will always be combined with an AV nodal blocker (beta-blocker or diltiazem/verapamil).

  • DrugSotalol or Amiodarone

    Class III anti-arrhythmic drug: Sotalol or amiodarone as per physician preference. Recommended starting doses: * Sotalol: 80 mg BID per os, with a dose adjustment to once daily if the eGFR is between 40 and 60 mL/min. * Amiodarone: loading dose of 600 mg daily per os in divided doses for 1 week, followed by 400 mg daily per os in divided doses for 1 week, and subsequently 200 mg per os once daily.

06

What researchers measure

Primary outcomes

  1. Composite safety outcome

    The primary outcome measure is a composite safety outcome including all-cause mortality, severe adverse events leading to drug discontinuation, and unscheduled hospitalisation for heart failure or acute coronary syndrome. Each of these individual components is assessed as secondary outcome.

    Time frame: 1 year

Secondary outcomes

  1. All-cause mortality

    Death from any cause

    Time frame: 1 year

  2. Severe adverse events leading to drug discontinuation

    Any severe AE leading to intervention discontinuation, including bradyarrhythmias, ventricular arrhythmias, atrial flutter with 1:1 conduction, QT/QRS prolongation, serious extra-cardiac adverse events

    Time frame: 1 year

  3. Unscheduled hospitalisation for heart failure or acute coronary syndrome

    Unscheduled hospitalisation for heart failure or acute coronary syndrome

    Time frame: 1 year

  4. AF recurrence

    Freedom from fast atrial arrhythmia post-treatment (clinical recurrence of AF)

    Time frame: 1 year

  5. Major adverse cardiovascular events

    Composite of cardiovascular death, myocardial infarction, stroke

    Time frame: 1 year

  6. Catheter ablation

    Incidence of catheter ablation for AF during follow-up

    Time frame: 1 year

  7. Cardiovascular hospitalisation duration

    Total number of days of cardiovascular hospitalisation

    Time frame: 1 year

  8. Treatment-related adverse events

    All serious adverse events and adverse events: * Frequency and severity of all treatment-emergent adverse events * Proportion of participants experiencing at least one AE/SAE. * Specific drug-related adverse events (e.g., QT prolongation, proarrhythmia, bradycardia, hypotension, fatigue, gastrointestinal disturbances).

    Time frame: 1 year

  9. Cardiac function - LVEF

    Changes in cardiac function assessed by left ventricular ejection fraction expressed in percentages (%) from baseline measured by echocardiography

    Time frame: 3 months

  10. NT-proBNP

    Change in N-terminal-pro-brain Natriuretic Peptide (NT-proBNP) at 3 months from baseline

    Time frame: 3 months

  11. QTc

    Change in QTc interval (ms) and QRS duration (ms) from baseline

    Time frame: 1 year

  12. Healthcare resource utilization

    Total within-trial healthcare resource utilization expressed in Euro (€)

    Time frame: 1 year

  13. Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire

    Change in patient reported outcomes assessed by the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. The AFEQT questionnaire is a 20-item, disease-specific, patient-reported outcome measure ranging from 0 to 100 with a higher value corresponding to a better quality of life.

    Time frame: 1 year

  14. EuroQoL-5 dimension health utility index (EQ-5D-5L)

    Change in patient-reported outcome as assessed by the EuroQoL-5 dimension health utility index (EQ-5D-5L) questionnaire. The EQ-5D-5L measures health-related quality of life across five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) on five severity levels (1=no problem to 5=extreme problem). Results are interpreted via a 5-digit health state profile (e.g., 11211), a calculated utility index (ranging from \<0 to 1, where 1=full health), and a 0-100 Visual Analog Scale (VAS). A higher score corresponds to a better quality of life.

    Time frame: 1 year

  15. Short Form-12 (SF-12) health survey

    Change in patient-reported outcome as assessed by the Short Form-12 (SF-12) health survey. The Short Form-12 (SF-12) health survey is interpreted by calculating two main, norm-based scores-the Physical Component Summary (PCS) and Mental Component Summary (MCS)-where a score of 50 represents the average for the general population. Scores above 50 indicate better-than-average health-related quality of life, while scores below 50 indicate below-average health.

    Time frame: 1 year

  16. EHRA symptom score

    Change in patient-reported outcome as assessed by the European Heart Rhythm Association (EHRA) symptom score. The EHRA symptom score is a standardized, four-level classification system used to quantify the severity of symptoms in patients with atrial fibrillation based on how they impact daily activities. EHRA Symptom Score Classification (I-IV): EHRA I (Asymptomatic): No symptoms are experienced. EHRA II (Mild Symptoms): Normal daily activity is not affected. EHRA III (Severe Symptoms): Normal daily activity is affected. EHRA IV (Disabling Symptoms): Normal daily activity is discontinued.

    Time frame: 1 year

  17. Work Productivity and Activity Impairment (WPAI) questionnaire

    Change in patient-reported outcome as assessed by the Work Productivity and Activity Impairment (WPAI) questionnaire. The WPAI questionnaire is interpreted by calculating four key impairment percentages over the past 7 days, with higher scores (0-100%) indicating greater impairment and lower productivity. It measures absenteeism (time missed), presenteeism (impairment while working), overall work loss, and daily activity impairment, using a 0-10 scale for productivity.

    Time frame: 1 year

07

Study locations

4 of 14 sites recruiting
08

References and documents

Individual participant data

Plan to share: Yes

Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Clinical study report

Time frame: Starting 12 months after publication

Access criteria: Upon reasonable request to the Principal Investigator

No publications or documents are linked to this record.

09

Timeline

2 registry updates since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Start is estimated for Sep 2026; primary completion for Dec 2029, 39 months later.

Of 129 non-industry phase 4 interventional studies under Atrial Fibrillation, half reached primary completion within 53 months of starting (the median), counting those still running; a quarter within 28 and three quarters within 81. This study's planned 39 months is below that.

Counting every sponsor, half of 141 studies reached it within 48 months; a quarter within 27 and three quarters within 81.

How these figures are worked out, and which studies are left out of them.

Registered
Jan 27, 2026
First posted
Feb 12, 2026
StartEst.
Sep 2026
Primary completionEst.
Dec 2029
CompletionEst.
Dec 2029
Last update
Oct 21, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
Sites
3 sites changed recruiting status (3 now recruiting)
Show 3 sites
  • AZorg · Aalst, BelgiumNot yet recruiting→Recruiting
  • AZ Turnhout · Turnhout, BelgiumNot yet recruiting→Recruiting
  • Universitair Ziekenhuis Antwerpen · Edegem, BelgiumNot yet recruiting→Recruiting
across 2 updates, Oct 14, 2026 – Oct 21, 2026
Eligibility
1 exclusion criterion edited, 14 added, 1 removed
What changed in the criteria
Exclusion criteria
  • AddedBaseline corrected QT interval (Fridericia) ≥ 500 ms
  • EditedBaseline corrected QT interval (Fridericia) ≥ 500 ms 11 Pre-existing advanced AV block (second-, or third-degree)
  • Removed12. Pre-existing sick sinus syndrome or sinus bradycardia <50 bpm 13. Known channelopathy 14. Contra-indication to AV-slowing agents, including beta-blockers, diltiazem or verapamil 15. Atrial fibrillation due to reversible cause 16. Active intracardiac thrombus 17. Acute coronary syndrome during the 3-month period preceding the consent date 18. Cardiac surgery, including coronary artery bypass surgery, during the 3-month period preceding the consent date or planned at a future date at the time of consent 19. Moderate or severe congenital heart disease as per 2020 ESC guidelines 20. Hypertrophic cardiomyopathy (septal or posterior wall thickness >1.5 cm) 21. Significant chronic kidney disease (eGFR <40 mL/min) 22. Life expectancy less than 1 year 23. Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate, highly effective contraceptive 24. Inability to provide written informed consent, including decision-making incapacity due to cognitive impairment or other medical or psychiatric conditions that preclude adequate understanding of the study and its procedures.
  • AddedPre-existing sick sinus syndrome or sinus bradycardia <50 bpm
  • AddedKnown channelopathy
  • AddedContra-indication to AV-slowing agents, including beta-blockers, diltiazem or verapamil
  • AddedAtrial fibrillation due to reversible cause
  • AddedActive intracardiac thrombus
  • AddedAcute coronary syndrome during the 3-month period preceding the consent date
  • AddedCardiac surgery, including coronary artery bypass surgery, during the 3-month period preceding the consent date or planned at a future date at the time of consent
  • AddedModerate or severe congenital heart disease as per 2020 ESC guidelines
  • AddedHypertrophic cardiomyopathy (septal or posterior wall thickness >1.5 cm)
  • AddedSignificant chronic kidney disease (eGFR <40 mL/min)
  • AddedLife expectancy less than 1 year
  • AddedFemale who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate, highly effective contraceptive
  • AddedInability to provide written informed consent, including decision-making incapacity due to cognitive impairment or other medical or psychiatric conditions that preclude adequate understanding of the study and its procedures.
Oct 14, 2026
Show all 2 updates
  1. Oct 21, 2026
    Universitair Ziekenhuis Antwerpen is now Recruiting
  2. Oct 14, 2026
    2 sites changed recruiting status (2 now recruiting)
    Show 2 sites
    • AZorg · Aalst, BelgiumNot yet recruiting→Recruiting
    • AZ Turnhout · Turnhout, BelgiumNot yet recruiting→Recruiting
    Eligibility 1 exclusion criterion edited, 14 added, 1 removed
    What changed in the criteria
    Exclusion criteria
    • AddedBaseline corrected QT interval (Fridericia) ≥ 500 ms
    • EditedBaseline corrected QT interval (Fridericia) ≥ 500 ms 11 Pre-existing advanced AV block (second-, or third-degree)
    • Removed12. Pre-existing sick sinus syndrome or sinus bradycardia <50 bpm 13. Known channelopathy 14. Contra-indication to AV-slowing agents, including beta-blockers, diltiazem or verapamil 15. Atrial fibrillation due to reversible cause 16. Active intracardiac thrombus 17. Acute coronary syndrome during the 3-month period preceding the consent date 18. Cardiac surgery, including coronary artery bypass surgery, during the 3-month period preceding the consent date or planned at a future date at the time of consent 19. Moderate or severe congenital heart disease as per 2020 ESC guidelines 20. Hypertrophic cardiomyopathy (septal or posterior wall thickness >1.5 cm) 21. Significant chronic kidney disease (eGFR <40 mL/min) 22. Life expectancy less than 1 year 23. Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate, highly effective contraceptive 24. Inability to provide written informed consent, including decision-making incapacity due to cognitive impairment or other medical or psychiatric conditions that preclude adequate understanding of the study and its procedures.
    • AddedPre-existing sick sinus syndrome or sinus bradycardia <50 bpm
    • AddedKnown channelopathy
    • AddedContra-indication to AV-slowing agents, including beta-blockers, diltiazem or verapamil
    • AddedAtrial fibrillation due to reversible cause
    • AddedActive intracardiac thrombus
    • AddedAcute coronary syndrome during the 3-month period preceding the consent date
    • AddedCardiac surgery, including coronary artery bypass surgery, during the 3-month period preceding the consent date or planned at a future date at the time of consent
    • AddedModerate or severe congenital heart disease as per 2020 ESC guidelines
    • AddedHypertrophic cardiomyopathy (septal or posterior wall thickness >1.5 cm)
    • AddedSignificant chronic kidney disease (eGFR <40 mL/min)
    • AddedLife expectancy less than 1 year
    • AddedFemale who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate, highly effective contraceptive
    • AddedInability to provide written informed consent, including decision-making incapacity due to cognitive impairment or other medical or psychiatric conditions that preclude adequate understanding of the study and its procedures.

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT07405671
Collaborators
Research Foundation Flanders
Responsible party
Sponsor
First posted
Feb 12, 2026
Start date
Sep 2026 (estimated)
Primary completion
Dec 2029 (estimated)
Completion
Dec 2029 (estimated)
Last update
Oct 21, 2026

Study contacts

Joris Ector, MD PhD
Contact
Joris.Ector@UZLeuven.be
+32 16 34 14 87
Bert Vandenberk, MD PhD MSc
Contact
bert.vandenberk@uzleuven.be

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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