A Case Report of Flecainide Toxicity With Review of Literature

Abstract

Flecainide is an anti-arrhythmic drug with a narrow therapeutic index. Flecainide toxicity is rare, but the mortality is high. This case demonstrates the use of intravenous fat emulsion therapy in conjunction with intravenous sodium bicarbonate treatment for flecainide toxicity.A 50-year-old male with atrial fibrillation and taking flecainide 75 mg twice daily presented to Emergency Department after ingesting 1125 mg of flecainide, in a suicide attempt. An electrocardiogram (ECG) on arrival showed bradycardia, wide QRS complex, prolonged QTc interval. Treatment for flecainide poisoning with intravenous sodium bicarbonate was initiated. On day two, the patient had a cardiac arrest secondary to ventricular tachycardia. After successful defibrillation, the patient had persistent bradycardia and hypotension. Administration of a 20% lipid emulsion bolus, followed by continuous infusion for three hours, resulted in conversion to normal sinus rhythm. This case illustrates the successful treatment of flecainide toxicity with intravenous fat emulsion therapy. To our knowledge, this is the second case that used fat emulsion without concomitant extracorporeal life support. Due to its low prevalence and the fact the lipid emulsion is often used in conjunction with other treatments, there are no randomized clinical trials on the isolated efficacy of lipid infusion. The best treatment is unknown. Given its high mortality, early detection and treatment are paramount.

A Rare Case Report of Flecainide-Induced Left Bundle Branch Block (LBBB) and Transient Cardiomyopathy

“…Therefore, small differences in dose or blood concentration can result in life-threatening adverse drug reactions. Flecainide toxicity can cause an excess blockade of the cardiac sodium channels, which can lead to delayed conduction, negative inotropy, and fatal arrhythmias, such as ventricular tachycardia and ventricular fibrillation [7]. Toxicity may be precipitated in patients with liver and/or renal failure secondary to decreased drug metabolization and clearance.…”

Usefulness of lipid emulsion for the management of cardiac toxicity in acute flecainide overdose

“…El tratamiento se basa en la descontaminación digestiva, administración de bicarbonato de sodio a altas dosis, fármacos inotrópicos, marcapasos transitorio y medidas de soporte. Las arritmias a menudo son refractarias a la cardioversión y la hemofiltración no es eficaz 4,5 . Aun no existiendo ensayos controlados aleatorios que prueben la eficacia de la ELI, debe considerarse como un antí-doto de rescate en la cardiotoxicidad por fármacos liposolubles, cuando las medidas habituales de reanimación cardiopulmonar sean ineficaces.…”