Irreversible third-degree heart block and pacemaker implant in a case of flecainide toxicity

Lloyd, Thomas; Zimmerman, Jacob; Griffin, Gregory

doi:10.1016/j.ajem.2013.04.025

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…In our patient, prompt sodium bicarbonate administration resulted in rapid resolution of the patient’s device failure to capture and cardiogenic shock. Cardiac pacing has previously been described as a treatment for flecainide toxicity [13]. While it may be helpful when patients present with complete heart block, our case and other cases described in the literature suggest that cardiac pacing may be of minimal benefit when the predominant issue is QRS widening [14,15].…”

Section: Discussionmentioning

confidence: 73%

Flecainide Toxicity Resulting in Pacemaker Latency and Intermittent Failure to Capture

et al. 2019

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Patient: Female, 91Final Diagnosis: Flecainide toxicitySymptoms: BradycardiaMedication: FlecainideClinical Procedure: —Specialty: CardiologyObjective:Unusual clinical courseBackground:Flecainide is a class Ic antiarrhythmic agent used in the treatment of supraventricular and ventricular arrhythmias. It is associated with a potent adverse effect profile; however, the effects of flecainide toxicity in the setting of a pacemaker have not been well described. We describe a unique case of flecainide toxicity secondary to acute kidney injury in the setting of a dual-chamber pacemaker, resulting in ventricular capture latency and intermittent failure to capture.Case Report:The patient was a 91-year-old female with a history of atrial fibrillation maintained in sinus rhythm on flecainide, who presented complaining of purple visual disturbances and syncope. She was found to be hypotensive and bradycardic, with a heart rate between 30 to 40 beats per minute. Lab work was notable for creatinine at 2.12 mg/dL. A 12-lead ECG demonstrated atrial and ventricular pacing with severely widened QRS complex and a significant latency between the pacemaker ventricular spike and the ventricular capture. The pacemaker was interrogated, revealing a significant increase in ventricular threshold from 0.75 V at 0.5 ms at baseline to 5.0 V at 1 ms to obtain consistent capture. After multiple boluses of IV sodium bicarbonate, the QRS acutely narrowed, latency interval improved, and consistent pacing capture was achieved. The flecainide level drawn on arrival was 3.09 mcg/mL.Conclusions:Flecainide increases the ventricular capture threshold for pacemakers. Toxicity in these patients may present with pacemaker ventricular capture latency or failure to capture.

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Section: Discussionmentioning

confidence: 73%

Flecainide Toxicity Resulting in Pacemaker Latency and Intermittent Failure to Capture

et al. 2019

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“…It is difficult to determine to what extent the improvement in the follow-up was the result of the dose reduction or to a compensation mechanism. Dizziness improvements have been described following either dose reduction or Flecainide replacement (38)(39)(40). It is important to highlight that BV can be diagnosed clinically at bedside with the headimpulse test.…”

Section: Discussionmentioning

confidence: 99%

A Possible Mechanism for Flecainide Induced Dizziness

Garaycochea

Garcia

Manrique-Huarte

et al. 2022

Otology &Amp; Neurotology

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Objective:Flecainide is an oral class IC antiarrhythmic drug whose most common extracardiac adverse reactions are “dizziness” and “visual disturbances.” We describe a case of flecainide associated- bilateral vestibulopathy and a literature review of this drug's effect on the vestibular system.Patient:Sixty-nine-year-old man with a 3-month history of unsteadiness and dizziness after an increase in the dose of flecainide.Interventions:Otologic examination, video head-impulse test, vestibular evoked myogenic potentials, pure tone audiometry and high-resolution magnetic resonance imaging.Results:Otologic examination, including the head-impulse test, and vestibular testing revealed bilateral vestibulopathy.Conclusions:Dizziness is a common extracardiac adverse reaction of Flecainide. Based on the clinical case that we present and the literature review carried out, we hypothesized that a possible mechanism by which flecainide might cause dizziness and visual disturbances is bilateral vestibulopathy.

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“…5,7,9,[11][12][13] The reported rate of this pro arrhythmic effect can be as high as 3.5% to 5%. 14,15 Flecainide toxicity can occur secondary to chronic ingestion and may be precipitated in mild renal failure. The majority of flecainide is renally excreted and the halflife is 20 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment includes increasing the excretion of flecainide, symptomatic support (including pacemaker placement, intravenous fat emulsion, or extracorporeal circulatory support) and administration of sodium bicarbonate, to transiently reverse the effect of the sodium channel blockade, in severe cases. [15][16][17]…”

Section: Discussionmentioning

confidence: 99%

Electrocardiography: Flecainide Toxicity

Apfelbaum¹,

Gerczynski²,

Robertson³

et al. 2018

Emerg Med

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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-

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Irreversible third-degree heart block and pacemaker implant in a case of flecainide toxicity

Cited by 9 publications

References 9 publications

Flecainide Toxicity Resulting in Pacemaker Latency and Intermittent Failure to Capture

Flecainide Toxicity Resulting in Pacemaker Latency and Intermittent Failure to Capture

A Possible Mechanism for Flecainide Induced Dizziness

Electrocardiography: Flecainide Toxicity

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