Torsade-de-pointes in a patient under flecainide treatment, an unusual case of proarrhythmicity

Asensio, Juan Manuel Nogales; Sánchez, Nieves Moreno; Vecino, Luis Javier Doncel; Mariscal, Celia Villar; López-Mínguez, José Ramón; Herrera, Antonio Merchán

doi:10.1016/j.ijcard.2006.07.124

Cited by 17 publications

(7 citation statements)

References 7 publications

(6 reference statements)

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“…This prolongation is linked to the risk of torsades de pointes ventricular tachycardia in humans . However, flecainide does not induce JTc prolongation in humans, and flecainide‐induced torsades de pointes ventricular tachycardia is rare . A JTc prolongation after flecainide infusion also was found in another study, but the association between this prolongation and torsades de pointes ventricular tachycardia in horses remains to be proven.…”

Section: Discussionmentioning

confidence: 97%

Time‐dependent antiarrhythmic effects of flecainide on induced atrial fibrillation in horses

Carstensen

Hesselkilde

Fenner

et al. 2018

Veterinary Internal Medicne

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BackgroundPharmacological treatment of atrial fibrillation (AF) in horses can be challenging because of low efficacy and adverse effects. Flecainide has been tested with variable efficacy.ObjectiveTo test whether the efficacy of flecainide is dependent on AF duration.AnimalsNine Standardbred mares.MethodsFactorial study design. All horses were instrumented with a pacemaker and assigned to a control or an AF group. On day 0, all horses were in sinus rhythm and received 2 mg/kg flecainide IV. Atrial fibrillation subsequently was induced in the AF group by pacemaker stimulation. On days 3, 9, 27, and 55, flecainide was administered to all horses, regardless of heart rhythm.ResultsAll horses in AF cardioverted to sinus rhythm on days 3 and 9. On day 27, 5/6 horses cardioverted, whereas only 2/6 cardioverted on day 55. The time from the start of flecainide infusion to cardioversion (range, 3–185 min, log transformed) showed linear correlation with the cumulative duration of AF (r 2 = .80, P < .0001). Flecainide induced abnormal QRS complexes in 4/6 AF horses and 1/3 controls. A positive correlation was found between heart rate before flecainide infusion and number of abnormal QRS complexes (0.14, P < .05). One horse suffered from cardiac arrest and died after flecainide infusion.Conclusions and Clinical ImportanceFlecainide is effective for cardioversion of short‐term induced AF, but the effect decreases with AF duration. Controlling heart rate may minimize adverse effects caused by flecainide, but the drug should be used with great caution.

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Section: Discussionmentioning

confidence: 97%

Time‐dependent antiarrhythmic effects of flecainide on induced atrial fibrillation in horses

Carstensen

Hesselkilde

Fenner

et al. 2018

Veterinary Internal Medicne

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“…A database literature search revealed only three such cases in patients with no additional triggers (electrolyte imbalance or medications). In all three cases, it was preceded by a bradyarrhythmia, perhaps providing the substrate for QT prolongation . Our patient was undergoing vigorous exercise and was unlikely to have been bradycardic; however, we cannot discount the fact that the effects of flecainide could have been enhanced by his exercise, leading to a transient bradycardia that served as the substrate for the development of his torsades de pointes.…”

Section: Discussionmentioning

confidence: 80%

“…Interestingly, our patient had a prolonged QT, most notably around the time of his cardiac arrest, without an associated increase in QRS duration as would be expected given flecainide's mechanism of action. There is a paucity of published information regarding the association of flecainide‐induced QT prolongation and the development of torsades de pointes in patients with a structurally normal heart . A database literature search revealed only three such cases in patients with no additional triggers (electrolyte imbalance or medications).…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Flecainide‐induced QT Prolongation Leading to Cardiac Arrest

et al. 2014

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Flecainide is recommended as a first-line antiarrhythmic drug to maintain normal sinus rhythm in patients with atrial fibrillation (AF) who have structurally normal hearts or hypertension without left ventricular hypertrophy. Flecainide is a sodium channel blocker with minimal effects expected on ventricular repolarization. We describe the case of a 32-year-old man with a structurally normal heart and persistent AF who was started on diltiazem and flecainide 50 mg twice/day approximately a year prior to presentation. Due to persistent and bothersome symptoms, his dose was increased to 150 mg twice/day, which was associated with a progressive lengthening of his corrected QT interval. On the day of presentation, he underwent an exercise test as part of his job requirements. While running, he felt lightheaded and experienced a syncopal event and cardiac arrest. An automated external defibrillator was available that displayed polymorphic ventricular tachycardia. The patient was successfully resuscitated. Although rare, this case suggests that flecainide can induce QT prolongation leading to torsades de pointes. Clinicians should be aware and consider periodic evaluations with electrocardiograms.

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“…Although flecainide, a fast inward sodium channel blocker, suppresses conductivity, it may perpetuate reentry in patients with structural heart disease. Proarrhythmia, induced by flecainide, has rarely been reported in patients without structural heart disease . Instead, it is mostly related to drug interaction with other antiarrhythmic drugs, electrolyte disorders, or 1:1 ventricular conduction of atrial flutter .…”

Section: Discussionmentioning

confidence: 99%

Flecainide‐Associated Bradycardia‐Dependent Torsade de Pointes: Another Potential Mechanism of Proarrhythmia

Kim

Pak

Park

et al. 2010

Pacing Clinical Electrophis

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Although flecainide has a risk of proarrhythmia in patients with structural heart disease, its mechanism has been mainly ascribed to use-dependency and a rapid ventricular response to organized atrial tachyarrhythmias or to ventricular tachycardia. We present a patient who experienced recurrent syncope due to bradycardia-dependent torsade de pointes (TdP) associated with flecainide-related bradycardia and QT prolongation. Bradycardia-dependent TdP with QT prolongation can be considered as one of mechanisms of flecainide-induced proarrhythmia.

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Torsade-de-pointes in a patient under flecainide treatment, an unusual case of proarrhythmicity

Cited by 17 publications

References 7 publications

Time‐dependent antiarrhythmic effects of flecainide on induced atrial fibrillation in horses

Time‐dependent antiarrhythmic effects of flecainide on induced atrial fibrillation in horses

An Unusual Case of Flecainide‐induced QT Prolongation Leading to Cardiac Arrest

Flecainide‐Associated Bradycardia‐Dependent Torsade de Pointes: Another Potential Mechanism of Proarrhythmia

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