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Clinical and Electrophysiologic Effects of Flecainide in Patients with Refractory Ventricular Tachycardia
Author(s) -
Capparelli Edmund V.,
Kluger Jeffrey,
Regnier Jane C.,
Chow Moses S. S.
Publication year - 1988
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/j.1552-4604.1988.tb03143.x
Subject(s) - flecainide , medicine , amiodarone , cardiology , anesthesia , refractory (planetary science) , ventricular tachycardia , tachycardia , atrial fibrillation , physics , astrobiology
The electrophysiologic effects and antiarrhythmic efficacy of flecainide were evaluated by electrophysiologic study (EPS) in 20 patients with ventricular tachycardia (VT) refractory to an average 2.9 drugs, In 19 patients EPSs were performed with patients not receiving antiarrhythmic medications and receiving oral flecainide therapy at steady state (mean dose, 235 ± 67 mg/day). Flecainide significantly increased the QRS complex duration (27%, P < .001), PR interval (17%, P < .001), and right ventricular effective refractory periods 8.5% and 21.1% (P < .01) for the first and second extrastimuli, respectively. During baseline EPS, 17 patients were induced into VT and two were noninducible. Flecainide prevented EPS‐induced VT in five patients and the induced VT became slow and hemodynamically stable in three. Two patients who failed flecainide monotherapy were induced into slow hemodynamically stable VT with flecainide in combination with amiodarone. The two noninducible patients, during baseline EPS, had suppression of spontaneous VT with flecainide. Overall, 13 of 20 patients received flecainide either alone or in combination with amiodarone for chronic therapy. Side effects encountered during the study consisted of blurred vision, dizziness, weakness, lethargy, nausea, worsened heart failure and bradyarrhythmias. After a mean 9‐month follow‐up (3 to 16 months), nine patients remain on flecainide therapy. There were three recurrences of slow, hemodynamically stable VT and no episodes of sudden death. Low‐dose flecainide, either alone or in combination with other agents, is effective therapy for certain patients with refractory VT but heart failure remains a significant concern in patients with depressed left ventricular function.