Ĭommon reactions to flecainide include dizziness, arrhythmias, dyspnea, visual disturbances, palpitations, chest pain, tremor, asthenia, abdominal pain, and constipation.įlecainide has an FDA Black Box Warning recommending restricting its use to life-threatening ventricular arrhythmias, as data show no surn=vival benefits without such arrhythmias. Flecainide has the potential to convert atrial fibrillation into atrial flutter with 1 to 1 conduction and also ventricular tachyarrhythmias, so beta-blockers or calcium channel blockers should be used concurrently. Therefore, its use in heart failure patients is contraindicated. It does not affect repolarization, so it exerts a mild effect on QT interval.įlecainide has a negative inotropic effect on cardiac muscles. Preexisting sinus node disease can result in profound bradycardia. These changes can result in prolonged PR intervals, first-degree heart block, and second-degree heart block. Flecainide prolongs depolarization and can slow conduction in the AV node, the His-Purkinje system. įlecainide has a proarrhythmic effect with an increased incidence of mortality and non-fatal cardiac arrest in patients with a history of myocardial infarction and asymptomatic premature ventricular contractions (PVCs)/non-sustained ventricular tachycardia (NSVT). It takes 1 to 6 hours to peak in serum after administration. In children: 8 hours, adolescents 12 to 15 years: approximately 11 hours, adults: 12 to 24 hours. In newborns: less than 28 hours, 3 months: 11 to 12 hours, 12 months: 6 hours. It is 40% protein-bound, and half-life elimination varies across age groups. Oral bioavailability is nearly 100% but decreases when administered with milk. Breastfeeding is acceptable as long as relative infant dosing is under 10%. The relative infant dosing is calculated using the highest average breast milk concentration compared to the maternal dosage. Fetuses may also experience neonatal hyperbilirubinemia, although this data is unclear.įlecainide is present in breast milk the relative infant dose is 8% when the maternal dosing is 200mg/day. Fetal risks include fetal heart rate variability, acceleration impairment, and QT interval abnormalities. Using flecainide during pregnancy may pose some risk to the fetus, so clinicians must perform a risk/benefit analysis. With renal disease and CrCl less than 35ml/min/1.73m^2, caution is necessary when increasing the dose at 4-day intervals.Ĭonsult facility guidelines or manufacturer prescribing data for pediatric dose regimens. No dosage changes are necessary for liver disease, as per the manufacturer. Dose adjustment is made based on serum levels. doi:10.1371/ 100 mg daily every 12 hours, and increase dosing by 100 mg per day every four days. The maximum dose is 400 mg daily. Mortality and causes of death in patients with atrial fibrillation: A nationwide population-based study. Comparative risks of ischemic stroke in atrial flutter versus atrial fibrillation. Lifestyle and risk factor modification for reduction of atrial fibrillation: a scientific statement from the American heart association. Living with atrial fibrillation.Ĭhung MK, Eckhardt LL, Chen LY, et al. How often atrial flutter and atrial fibrillation coexist? Results from a large nationwide ECG-based study. Journal of the American College of Cardiology. Important differences exist between atrial fibrillation and atrial flutter in atrial remodeling. Atrial fibrillation: causes and risk factors.Ĭalkins H. National Heart, Lung, and Blood Institute. Diagnosing atrial fibrillation & atrial flutter. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF pilot general registry. Stroke history higher in asymptomatic versus symptomatic atrial fibrillation patients.īoriani G, Laroche C, Diemberger I, et al. Comparing outcomes in asymptomatic and symptomatic atrial fibrillation: a systematic review and meta-analysis of 81,462 patients. Sgreccia D, Manicardi M, Malavasi VL, et al. Heart matters: What's the difference between atrial flutter and atrial fibrillation?Īmerican Heart Association.
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