The effect of flecainide in 12 patients with the Wolff-Parkinson-White syndrome was analyzed with respect to the anterograde and retrograde conduction properties of the accessory pathway, the modes of initiation and termination of circus movement tachycardias, and the ventricular response during induced atrial fibrillation. The principal effect of this drug was to depress both anterograde and retrograde conduction of the accessory pathway. In 8/9 cases circus movement tachycardia was terminated by prolongation of the retrograde effective refractory period of the accessory pathway. Flecainide increased the shortest and the mean cycle length during induced atrial fibrillation. It is concluded that the drug may be of potential benefit in patients with paroxysmal supraventricular tachycardias in patients with the Wolff-Parkinson-White syndrome.

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A previously healthy 71-year-old man presented with acute onset epigastric pain and was diagnosed with gallstone pancreatitis complicated by septic shock, acute kidney injury, and hypoxemic respiratory failure. Abdominal computed tomography (CT) scanning showed necrotizing pancreatitis. He was transferred to the intensive care unit (ICU) for mechanical ventilation, hemodynamic support, and further medical care. He did not require continuous pharmacological neuromuscular blockade or corticosteroids at any point. Due to clinical findings of abdominal compartment syndrome, the patient underwent decompressive laparotomy, followed by temporary maintenance of an open abdomen, on day 4 of admission. Laparotomy confirmed necrotizing gallstone pancreatitis, as well as an ischemic left colon necessitating resection. Multiple surgeries were required, including complete colectomy, creation of end-ileostomy, cholecystectomy, pancreatic debridement, abscess drainage, and finally wound closure on day 14 of admission.Despite discontinuation of sedation 1-week post admission, the patient exhibited profound generalized weakness including severe quadriparesis and ophthalmoplegia. The patient was consistently able to perform multistep tasks such as, "Tap your left index finger once, tap your right middle finger twice, and then tap with your left index finger again." The patient continued to demonstrate wakefulness through a tapping communications method developed in the ICU. Pupils were 3-4 mm with a sluggish light response. Bilateral C a n a d i a n J o u r n a l o f G e n e r a l I n t e r n a l M e d i c i n e 34V o l u m e 1 1 , I s s u e 1 , 2 0 1 6 Pseudo-Locked-In Syndrome and Apnea Due to Critical Illness Myopathy AbstractCritical Illness myopathy and polyneuropathy are common complications that occur in critically ill patients. Critical Illness myopathy and polyneuropathy are typically recognized in the ICU setting by the development of acquired weakness and failure to wean from ventilatory support. We report a case of a patient who developed severe critical illness myopathy that resulted in near-quadriplegia, apnea and ophthalmoplegia.