A case of electrolyte disturbances leading to flecainide toxicity at normal serum levels and pacemaker malfunction

Kasia, Christopher; Henry, Christopher; Santucci, Peter

doi:10.1016/j.hrcr.2019.05.007

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Flecainide possesses a narrow therapeutic index and steep dose–response relationship warranting close observation when administered 1,3 . When used in properly selected patients with serum levels maintained within a therapeutic range, flecainide is highly efficacious and possesses a good safety profile, with rare reports of toxicity occurring at normal serum levels 4 …”

Section: Discussionmentioning

confidence: 99%

Flecainide‐induced AV dyssynchrony and atrial latency progression in a patient with a dual‐chamber pacemaker

Alston

Chang

Mitra

2021

Cardiovasc electrophysiol

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Introduction Flecainide is a class 1C antiarrhythmic primarily usedfor the management of supraventricular arrhythmias. Adverse effects in patientswith pacemakers are poorly described in the current literature. We report acase of worsening intracardiac conduction in a patient with baseline atriallatency. Case A patient with paroxysmalatrial fibrillation and recently implanted dual chamber pacemaker withresultant atrial latency underwent flecainide treatment resulting in worseningatrial latency, progressive dyspnea, and pacemaker syndrome physiology. The patientexperienced symptomatic improvement with pacemaker reprogramming to AAI andreduced flecainide dosages. Conclusion Prudence should be exercised when initiating flecainide therapy, particularly in pacemaker‐dependentpatients, who may be at risk for increasedthresholds, inconsistent capture, and latency. In the setting of apparentcapture latency, changing to AAI mode may both confirm the diagnosis andprovide a symptomatic benefit.

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Section: Discussionmentioning

confidence: 99%

Flecainide‐induced AV dyssynchrony and atrial latency progression in a patient with a dual‐chamber pacemaker

Alston

Chang

Mitra

2021

Cardiovasc electrophysiol

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“…Among these, generator failure and lead failure are relatively rare and less likely to be the cause of pacemaker malfunction in the present patient, since device evaluation immediately before and after surgery showed normal function. In contrast, failure to capture is known to be associated with various pathological conditions such as myocardial ischemia, 4 acid-base disturbance, electrolyte abnormalities, 5 and elevated plasma concentration of antiarrhythmic drugs. 5 , 6 In the present patient, electrocardiography and echocardiography showed no evidence of myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, failure to capture is known to be associated with various pathological conditions such as myocardial ischemia, 4 acid-base disturbance, electrolyte abnormalities, 5 and elevated plasma concentration of antiarrhythmic drugs. 5 , 6 In the present patient, electrocardiography and echocardiography showed no evidence of myocardial ischemia. Arterial blood gas analysis showed no evidence of acid-base abnormality or electrolyte disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to capture is an important etiology of pacemaker malfunction. Known causes include myocardial ischemia, 4 acid-base disturbances, electrolyte imbalance, 5 and antiarrhythmic drugs. 5 , 6 Therefore, patients with pacemakers are at risk of capture failure during surgery and anesthesia.…”

mentioning

confidence: 99%

“…Known causes include myocardial ischemia, 4 acid-base disturbances, electrolyte imbalance, 5 and antiarrhythmic drugs. 5 , 6 Therefore, patients with pacemakers are at risk of capture failure during surgery and anesthesia. We describe a patient with a pacemaker who developed sudden cardiac arrest due to pacemaker capture failure shortly after laparotomy and ultrasound-guided rectus sheath block.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report

et al. 2021

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We describe a patient with a pacemaker who developed cardiac arrest shortly after ultrasound-guided rectus sheath block for postoperative analgesia. The cause of cardiac arrest was capture failure due to an increased pacing threshold, and the patient was promptly treated by increasing the pacing amplitude. Local anesthetics used for rectus sheath block might have affected the pacing threshold and caused pacing capture failure, since local anesthetics can block cardiac sodium channels. Anesthesiologists should recognize the risk of pacemaker capture failure when a large amount of local anesthetic is given to patients with a cardiac pacemaker.

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Enalapril/flecainide/hydrochlorothiazide

2019

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A case of electrolyte disturbances leading to flecainide toxicity at normal serum levels and pacemaker malfunction

Cited by 6 publications

References 17 publications

Flecainide‐induced AV dyssynchrony and atrial latency progression in a patient with a dual‐chamber pacemaker

Flecainide‐induced AV dyssynchrony and atrial latency progression in a patient with a dual‐chamber pacemaker

Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report

Enalapril/flecainide/hydrochlorothiazide

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