Flecainide single oral dose for management of paroxysmal supraventricular tachycardia in children and young adults

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

“…191 The precise location of the focal AT is ultimately confirmed by mapping during EP studies when successful ablation is achieved. [123][124][125][126][127][192][193][194][195][196] Focal AT has been localized to the crista terminalis, right or left atrial free wall or appendage, tricuspid or mitral annulus, paraseptal or paranodal areas, pulmonary veins, coronary sinus, and coronary cusps, but it originates more frequently from the right atrium than from the left atrium. 197,198 The underlying mechanism of focal AT can be automatic, triggered activity, or microreentry, but methods to distinguish the mechanism through pharmacological testing or EP study are of modest value because of limited sensitivity and specificity.…”

Oral verapamil in paroxysmal supraventricular tachycardia recurrence control: a randomized clinical trial

“…In addition, 50 of 51 PSVT episodes occurring during 5 ± 1 months of follow up were converted within 3 h (conversion time 21 ± 16 min) after a single diltiazem plus propranolol oral dose with no major drug-related adverse effects [Yeh et al 1985]. There are similar studies with other antiarrhythmic drugs like flecainide [Musto et al 1992]. Some other studies have used calcium channel blockers to control the ventricular rate in patients with chronic atrial flutter or atrial fibrillation (in conjunction with digoxin) and in prophylaxis of repetitive paroxysmal supraventricular tachycardia [Mangrum and DiMarco, 2002].…”

Flecainide administration in children: dosage, drug levels, and clinical effect

“…Previous studies have reported a correlation between plasma flecainide concentration and clinical effect while others report incessant arrhythmia despite adequate plasma flecainide concentration and attribute this to reasons other than underdosing. 11,12 Till et al reported a wide range of plasma flecainide concentration values, including supposedly subtherapeutic values, that were all related to patients whose arrhythmia was controlled. 4 This remains an area of uncertainty.…”