What is the use of Flecainide (anti-arrhythmic medication)?

From the Guidelines

Flecainide is recommended for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, or verapamil are ineffective or contraindicated, with a Class IIa recommendation 1. Flecainide is a Class IC antiarrhythmic medication primarily used to treat certain types of abnormal heart rhythms, particularly supraventricular tachycardias and ventricular arrhythmias in patients without structural heart disease.

Key Points

• The typical starting dose is 50-100 mg taken orally twice daily, which may be increased gradually to a maximum of 400 mg daily based on response and tolerability.
• Flecainide works by slowing electrical conduction in the heart by blocking sodium channels, which helps restore normal rhythm.
• It's particularly effective for conditions like atrial fibrillation, atrial flutter, and certain types of ventricular tachycardias.
• However, flecainide should not be used in patients with structural heart disease, heart failure, or previous heart attacks due to increased risk of proarrhythmic effects.
• Common side effects include dizziness, visual disturbances, headache, and nausea.
• Regular ECG monitoring is necessary during treatment to assess QRS duration and PR interval.
• Patients should be aware that flecainide has numerous drug interactions, particularly with other medications that affect heart rhythm, and should inform all healthcare providers about taking this medication.

Considerations

• Flecainide has a risk of proarrhythmia in patients with structural heart disease or ischemic heart disease and is contraindicated in these patient groups 1.
• In patients without structural heart disease, 7.6% discontinued the drug due to a suboptimal clinical response, and 5% discontinued it because of noncardiac (usually central nervous system) side effects 1.
• Class Ic agents (ie, flecainide and propafenone) are often combined with beta-blocking agents to enhance efficacy and reduce the risk of one-to-one conduction over the AV node if atrial flutter occurs 1.

From the FDA Drug Label

In patients without structural heart disease, flecainide acetate tablets, USP are indicated for the prevention of: •paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms •paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms Flecainide acetate tablets, USP are also indicated for the prevention of: •Documented ventricular arrhythmias, such as sustained ventricular tachycardia (sustained VT), that in the judgment of the physician are life-threatening

Flecainide is indicated for the prevention of:

• Paroxysmal supraventricular tachycardias (PSVT)
• Paroxysmal atrial fibrillation/flutter (PAF)
• Documented ventricular arrhythmias, such as sustained ventricular tachycardia (sustained VT) 2

From the Research

Flecainide Overview

• Flecainide is a class Ic antiarrhythmic agent used to treat various cardiac arrhythmias, including supraventricular tachyarrhythmias and ventricular arrhythmias 3, 4, 5, 6, 7.
• It works by inhibiting Nav1.5 sodium channels in heart muscle cells and modulating cardiac conduction 7.

Efficacy and Safety

• Flecainide has been shown to be effective in treating paroxysmal supraventricular tachycardias, including atrial fibrillation, with a good safety profile in patients without structural heart disease 3, 4, 5, 6.
• The drug has been demonstrated to be safe and well-tolerated, with a low risk of proarrhythmic events in patients without underlying structural heart disease 5, 6.
• Flecainide has been compared to other antiarrhythmic drugs, such as propafenone, and has been found to have a similar or better efficacy and safety profile 6.

Clinical Uses

• The main indication for flecainide is the treatment of paroxysmal supraventricular tachycardias, including atrial fibrillation, atrioventricular nodal re-entrant tachycardia, and atrioventricular re-entrant tachycardia 7.
• Flecainide may also be used in some supraventricular tachycardia in children and for sustained fetal tachycardia 7.
• The drug can be used successfully in both the acute and chronic treatment of cardiac arrhythmias 7.

Special Populations

• Flecainide can be used in children for the treatment of supraventricular tachycardia 7.
• The drug may also be used in pregnant women, but its use should be carefully considered and monitored 7.