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Effect of the Antiarrhythmic Agent Flecainide Acetate on Acute and Chronic Pacing Thresholds
Author(s) -
HELLESTRAND K.J.,
BURNETT P.J.,
MILNE J.R.,
BEXTON R.S.,
NATHAN A.W.,
CAMM A.J.
Publication year - 1983
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1983.tb04410.x
Subject(s) - flecainide , medicine , volt , anesthesia , pulse (music) , cardiology , atrial fibrillation , power (physics) , physics , quantum mechanics , detector , electrical engineering , engineering
To determine the effect of flecainide acetate, a Class IG antiarrnythmic drug, the medication was given to 28 patients with ventricular pacing electrodes. Eleven patients with temporary pacing electrodes (Group I) received intravenous flecainide (2 mg/kg over 10 minutes). Ten patients with chronic permanent electrodes (Group II) were given the same dose at the time of elective pulse generator change. Seven, with implanted multiprogrammable pacemakers capable of threshold analysis (Group III), were given intravenous flecainide and 5 of these were then given the drug orally for up to 3 weeks (100 mg/day increasing to 400 mg/day). In Group I the threshold measured at a pulse width of 0.5 ms rose from a control value of 0.66 to 1.44 volts after 10 minutes (p < 0.01). In Group II the threshold rose from 1.73 to 2.13 volts (p < 0.01) and 2 patients had total suppression of their ventricular escape rhythm for approximately one hour. In Group III patients, intravenous flecainide resulted in a rise of the pulse width threshold measured at 2.7 volts from 0.14 to 0.22 ms (p<0.02) and at 4.9 volts from 0.06 to 0.11 ms (p<0.05) after 10 minutes. After 3 weeks of oral therapy the threshold at 2.7 volts had risen from 0.09 to 0.28 ms (p < 0.02) and al 4.9 volts from 0.06 to 0.16 ms (p< 0.05). Flecainide significantly increased both acute and chronic thresholds and the most marked rise (> 200%) occurred during chronic oral therapy. Both intravenous and oral flecainide should be used with care in patients with either temporary or permanent pacing systems.