The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events

Abstract

Abstract. Almroth H, Andersson T, Fengsrud E, Friberg L, Linde P, Rosenqvist M, Englund A (Ö

Factors predisposing to ventricular proarrhythmia during antiarrhythmic drug therapy for atrial fibrillation in patients with structurally normal heart

“…A previous report found an increased incidence of sudden cardiac death and proarrhythmic events in AF patients treated with flecainide. 20 In comparison to our study, the study did not include the J wave as a variable. In addition, detailed univariate/multivariate analyses with/without the presence of VA were not performed.…”

“…There is general evidence that treating AF patient with propafenone in the absence of beta-blockers or calcium channel blockers may organize AF into atrial flutter with 1:1 conduction. 2,20 Before beginning therapy with these agents, a beta-blocker or calcium channel blocker should be given to prevent rapid AV conduction or 1:1 AV conduction if atrial flutter develops. The result suggests that rate control medication might be underused before initiation of Class IC medication.…”

CYP2D6 genotype affects age-related decline in flecainide clearance

“…CYP2D6*10 with low or unstable enzymatic activity is more prevalent in Japanese (38.8%) than in Caucasians (3.0%) [21]. This difference may be the reason behind the difference in the maintenance dose for Japanese (100 mg/day [22]) and Caucasians (200 mg/day [23]). Our findings also support a dose reduction for elderly patients according to the information found on the package inserts of flecainide acetate in Japan.…”

Flecainide-induced incessant orthodromic atrioventricular reentrant tachycardia in Wolff-Parkinson-White syndrome: Uneven depression of accessory pathway conduction

“…A 16-year-old male subject with a structurally normal heart and a manifest right-sided AP consistent with a paraseptal location 5 (Figure 1A) presented with recurrent palpitations. A supraventricular tachycardia was documented with a cycle length of 220 msec (Figure 2A).…”

“…A similar proarrhythmic effect has not been described with antiarrhythmic drugs in patients with an AP. In fact, the literature only describes the proarrhythmic effect of flecainide causing atrial flutter or ventricular tachycardia,5, 6 but not the development of incessant supraventricular tachycardia in subjects with an AP. In the present report we describe a patient with Wolff-Parkinson-White syndrome due to a right paraseptal AP in whom the administration of flecainide resulted in an incessant form of AVRT resembling the permanent form of junctional reciprocating tachycardia.…”