flecainide

see also:

use of flecainide in patients with structural heart disease, and particularly those with ejection fraction < 40% has been associated with life threatening and occasionally fatal ventricular arrhythmias.
thus flecainide should be avoided unless there is echocardiographic evidence of absence of structural heart disease or severe LVF

not recommended for Mx of chronic atrial fibrillation as it increases the risk of fatal ventricular arrhythmias
not recommended for patients with sick sinus syndrome as risk of sinus bradycardia, sinus pause or sinus arrest requiring pacemaker intervention
not recommended for use in digoxin toxicity
not recommended in patients with pacemakers as it may increase endocardial pacing thresholds
correct any electrolyte disturbances prior to use
should not be used during pregnancy unless as a drug of last resort in life threatening arrhythmias
flecainide has a mild negative inotropic effect

intravenous flecainide should only be used in a resuscitation facility with cardiac monitoring and availability of defibrillation (and preferabbly external pacing)

introduction

flecainide belongs to the membrane stabilising (class I) group of anti-arrhythmic agents
it depresses conduction in all parts of the heart with the greatest effect on the His-Purkinje system
does not usually alter heart rate
may prolong the PR interval, QRS duration and the QTc
flecainide has a long plasma half life of 12-27hrs after multiple oral doses

usual adult dose for emergent situations in resuscitation facilities:
- slow injection of 2 mg/kg over not less than ten minutes (can be diluted in 5% glucose)
- NOT compatible with chloride (ie. saline solutions!!)