Electrocardiography: Flecainide Toxicity

Abstract

An 86-year-old woman, who recently had been seen in the same facility after a ground level fall, presented to the ED with to a 2-to 3-day history of vague abdominal pain, increasing weakness, nausea, and dry heaves.Upon examination, the patient was unable to stand due to generalized weakness She arrived at the ED via emergency medical services. Her vital signs at presentation were significant for a systolic blood pressure (BP) of 90 mm Hg with a wide complex tachycardia concerning for ventricu-

First Case of Acute Poisoning with Amiodarone and Flecainide in Attempted Suicide Successfully Managed with Lipid Emulsion Therapy in the Emergency Department: Case Report and Literature Review

“…To our knowledge, this is the first report of a suicide attempt after intentional ingestion of large doses of amiodarone and flecainide with severe cardiotoxicity and a favorable evolution after LET in the ED. There are reports of accidental overdose in patients treated chronically with flecainide, especially in elders with hepatic or renal comorbidities, that were resolved in the ICU [32,34,37]. There are also reports of flecainide-induced therapy resistant ventricular fibrillation followed by cardiac arrest, successfully treated with cardiopulmonary resuscitation and advanced life support, where amiodarone was used as part of the protocol [19,29,32].…”

“…There are reports of accidental overdose in patients treated chronically with flecainide, especially in elders with hepatic or renal comorbidities, that were resolved in the ICU [32,34,37]. There are also reports of flecainide-induced therapy resistant ventricular fibrillation followed by cardiac arrest, successfully treated with cardiopulmonary resuscitation and advanced life support, where amiodarone was used as part of the protocol [19,29,32]. From the studies analyzed, only in one case of accidental flecainide overdose was the patient managed successfully in the ED with Na bicarbonate [36].…”