Flecainide is a class 1C antiarrhythmic drug especially used for
the management of supraventricular arrhythmia. Flecainide also has a recognized
proarrhythmic effect in patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias
including paroxysmal fibrillation,
Paroxysmal Supraventricular tachycardia and ventricular
Flecainide works by regulating the flow of sodium in the heart, causing prolongation of the cardiac action
potential. The proarrhythmic
effects however noted are not widely reported.
We report a case of paroxysmal atrial fibrillation with
structurally normal heart who was treated with oral Flecainide. Despite
subjective improvement and no adverse events [QTc prolongation] a repeat holter
detected him to have multiple short non sustained ventricular arrhythmias.
Development of ventricular arrhythmias, salvos & non sustained
ventricular tachycardia after a month of initiation of oral Flecainide detected
by 24 hours ECG holter lead to discontinuation of Flecainide and subsequent
early electro physiological studies and successful ablation.
Initiation of oral Flecainide in a case of atrial fibrillation
with subjective improvement and regular ECG monitoring, no QTc prolongation can
still lead to development of dangerous ventricular arrhythmias. A cautious
approach and thorough investigations and follow up are recommended.
Credits: Manish Barman;Bendaas Djamel